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HX641 37074 
RC31 3.C76  C76      Report  of  Special  Co 


RECAP 


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REPORT 


SPECIAL    COMMISSION 


APPOINTED  TO  INVESTIGATE 


TUBERCULOSIS 


REPORT  PRESENTED  TO  THE  GENERAL  ASSEMBLY  OF  igog 


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State  of  (Tonnecticut 

PUBLIC  DOCUMENT— SPECIAL 


REPORT 

OP 

SPECIAL    COMMISSION 

APPOINTED  TO  INVESTIGATE 

TUBERCULOSIS 


COMMISSION   APPOINTED   BY 

THE  GENERAL  ASSEMBLY 

OF   1907 

H.  J.  RESOLUTION  No.  426 

APPROVED    JULY    17,    1907 


REPORT  PRESENTED  TO  THE  GENERAL  ASSEMBLY  OF  iQog 


HARTFORD 

Published  by  the  State 
1908 


Publication 

Approved  by 

The  Board  of  Control. 


THE  TUTTLE,  MOREHOUSE  &  TAYLOR  COMPANY 
NEW  HAVEN 


INTRODUCTION. 


The  appointment  of  a  commission  by  the  last  legislature  of  the 
State  of  Connecticut,  for  the  investigation  of  tuberculosis  in  its 
relation  to  the  welfare  of  the  citizens  of  the  State  and  to  make 
such  suggestions  as  may  seem  practicable  and  suitable  for  the 
control  of  that  disease,  is  a  most  significant  act.  It  is  a  recogni- 
tion of  the  prevalence  and  serious  import  of  the  disease  through- 
out the  State — in  every  city,  town  or  hamlet — a  disease  so  widely 
distributed  and  so  destructive  to  the  interests  of  all  who  fall 
under  its  influence,  that  no  man  in  the  State  can  truthfully  say 
that  it  is  a  matter  of  no  interest  to  him. 

It  is  further  a  recognition  of  the  all-important  truth,  that  as  a 
result  of  modern  investigation,  the  control  of  a  disease,  once 
believed  to  be  beyond  human  relief,  has  been  made  possible.  The 
widespread  distribution  of  the  disease  has  placed  its  control 
beyond  the  power  of  individual  effort  and  imposes  the  duty  upon 
the  State — a  duty  that,  properly  performed,  must  be  of  the 
broadest  possible  economic  value  to  the  whole  community. 

The  people  have  a  right  to  demand  the  assistance  of  the  State 
in  the  war  against  tuberculosis.  Every  industrious  man  of 
ordinary  intelligence  understands  that  good  health  is  the  most 
valuable  asset  he  can  possess.  If  it  is  sacrificed  through  his  own 
personal  shortcomings,  he  has  himself  to  blame,  and  he  has  no 
claim  upon  the  State  beyond  what  is  now  given  to  such  unfor- 
tunates in  our  institutions  for  the  poor.  But  when  the  health  of 
a  man  is  sacrificed,  through  governmental  indifference  to  proper 
hygienic  precautions — when  he  is  tuberculous,  because  of  being 
compelled  to  breathe  air  that  might  have  been  pure  if  simple  rules 
had  been  properly  enforced — then  such  a  man  has  a  right  to  look 
to  the  State  for  redress.  No  one  questions  his  right  to  look  to  the 
State  for  protection  of  his  property  interests — why  is  this  not 
equally  true  of  his  health,  which  is  the  basis  of  material  pros- 
perity in  every  community? 


2  REPORT   OF   THE    COMMISSION 

In  preparing  this  report,  your  Commission  has  endeavored  to 
avoid  questions  that  are  still  under  discussion  and  to  place  before 
the  State  a  simple  and  practical  statement  of  conditions  as  they 
exist,  with  such  recommendations  for  the  control  of  tuberculosis 
as  may  seem  to  be  of  value  and  at  the  same  time  within  the  power 
of  the  State  to  adopt.  Investigation  into  the  duty  of  the  State 
in  the  effort  to  control  tuberculosis,  calls  for  consideration  of  the 
two  most  important  forms  of  the  disease — ^the  human  and  the 
bovine.  It  will  be  shown  in  this  report  that  there  are  many  points 
at  which  the  treatment  of  these  two  types  of  tuberculosis  is 
identical.  There  are  other  considerations  that  point  to  the 
wisdom  of  considering  them  separately.  It  is  highly  desirable 
that  the  widespread  impression  that  the  movement  to  suppress 
bovine  tuberculosis  is  solely  in  the  interest  of  the  effort  to  control 
human  tuberculosis,  should  be  corrected.  If  this  was  the  truth, 
surely  no  higher  motive  could  be  conceived  of.  But  the  arrest 
of  tuberculosis  in  the  herds  of  the  State  has  become  a  matter  of 
extreme  importance  to  the  welfare  of  that  industr}^  Until 
recently  there  has  been  so  much  effort  to  discredit  the  transmis- 
sibility  of  bovine  tuberculosis  to  the  human  being,  that  the 
owners  of  cattle  have,  in  the  earnestness  of  the  discussion, 
encouraged  themselves  in  the  belief  that  they  were  being  perse- 
cuted, that  their  property  rights  were  being  invaded.  Your 
Commission  feels  that  by  a  separate  discussion  of  the  bovine 
disease,  it  may  be  made  clear  that,  independent  of  all  altruistic 
motives,  it  is  to  the  interest  of  every  owner  of  cattle  to  assist 
the  State  in  suppressing  the  disease  that  is  extending  alarmingly 
and  is  seriously  imperiling  the  dairy  interest. 


FOR   THE   INVESTIGATION    OF   TUBERCULOSIS. 


TUBERCULOSIS  IN   NEW   ENGLAND. 


It  is  an  interesting  question  whether  tuberculosis  was  introduced 
into  New  England  by  the  white  settlers  or  was  already  present 
among  the  Indians.  There  are,  of  course,  no  official  records  of 
the  fact,  but  the  historical  references  to  consumption  as  a  disease 
destructive  to  the  Indians  are  suggestive. 

Daniel  Gookin,  himself  one  of  the  earlier  settlers  of  New 
England,  says  in  his  "Historical  Collections  of  the  Indians  of 
New  England" :  "Of  this  disease  of  the  consumption  sundry  of 
those  Indian  youths  died  that  were  bred  up  to  school  among  the 
English.  The  truth  is  this  disease  is  frequent  among  the  Indians ; 
and  sundry  die  of  it  that  live  not  with  the  English.  A  hectick 
fever  issuing  in  a  consumption  is  a  common  and  mortal  disease 
among  them."  ("Collections  of  the  Massachusetts  Historical 
Society,"  vol.  i,  page  173.)  This  would  indicate  that  the  cases 
referred  to  were  possibly  contracted  by  contact  with  the  whites. 

On  page  140  of  the  same  volume,  an  Indian  authority  is  given 
for  the  following  statement:  "Before  the  English  came  among 
the  Indians,  there  was  two  disorders  from  which  they  most  gen- 
erally died,  viz. :  the  consumption  and  the  yellow  fever." 

In  vol.  7  of  the  "Massachusetts  Historical  Collections,"  Gen- 
eral Lincoln  says,  in  observations  of  the  Indians  of  North 
America :  "Their  tender  lungs  are  greatly  affected  by  colds  which 
bring  on  consumptive  habits,  from  which  disorder,  if  my  informa- 
tion is  right,  a  large  proportion  of  them  die." 

Francis,  in  his  life  of  John  Eliot,  the  Apostle  of  the  Indians, 
gives  as  his  own  opinion :  "Consumption  seems  to  have  been  a 
common  malady  among  the  New  England  natives." 

De  Forest,  on  page  20  of  his  "History  of  the  Indians  of  Con- 
necticut," says :  "The  diseases  of  the  Indians  were  quinsies,  pleu- 
risies, rheumatisms,  quick  consumption  and  such  others  as  would 
be  naturally  produced  by  their  exposure  and  hardships,  and  by 
their  irregular  mode  of  life." 


4  REPORT   OF   THE    COMMISSION 

In  a  notable  series  of  papers  in  the  New  York  Medical  Record 
in  August  and  September,  1892,  on  "Diseases  Among  Indians," 
Dr.  A.  B.  Holder,  at  one  time  Agency  Physician  at  the  Crow- 
Reservation  in  Montana,  says :  "I  do  not  believe  that  at  any  time 
in  their  history  they  (the  Indians  of  North  America)  have  been 
free  from  consumption  and  scrofula.  Tuberculosis  is  coexten- 
sive with  the  Indian  race.  The  single  tribe  that  may  be  said  to 
be  free  from  this  disease,  I  have  been  unable  to  find  after  diligent 
search.  Those  who  inhabit  the  torrid  swamp  of  Arizona,  and 
those  in  the  frozen  northwest  territory  of  Canada,  along  the 
western  seaboard  and  in  the  Atlantic  States,  all  tribes  suffer  more 
or  less  from  consumption  and  scrofula." 

Addison,  in  the  Canadian  Journal  of  Medicine  and  Surgery  for 
May,  1902,  tells  of  finding  in  an  ossuary,  near  Big  Bay  Point,  in 
Simcoe  County,  Ontario,  several  skeletons  of  Huron  Indians  that 
had  suffered  from  Pott's  disease.  These  skeletons  had  been 
under  ground  for  more  than  two  centuries.  He  concludes  that 
these  bones  are  proof  that  not  only  the  Indians  suffered  from 
tuberculosis  before  the  European  invasion,  but  also  that  it  was  a 
very  common  disease  among  them  before  the  white  man  came. 

"In  Peabody  Museum  (specimen  17,223),  among  prehistoric 
remains,  is  a  part  of  a  vertebral  column  badly  affected  with  caries- 
tuberculosis."     (Holder.) 

Certainly  no  evidence  is  shown  in  these  quotations  that  can  be 
accepted  as  proof  that  tuberculosis  existed  among  the  Indians 
prior  to  the  advent  of  the  white  races,  except  such  as  may  be 
inferred  from  the  discovery  of  skeletons  clearly  indicating  tuber- 
culosis and  possibly  of  great  antiquity.  It  is  a  known  fact,  as 
shown  in  the  quotation  from  Dr.  Holder's  paper,  that  since  white 
settlement,  tuberculosis  has  been  fearfully  prevalent  among  all 
Indian  tribes  and  has  in  many  instances,  practically  decimated 
them.  This  statement  may  seem  surprising  to  those  who  regard 
the  Indian  as  a  child  of  nature — living  the  simplest  life  possible, 
in  pure  air  and  sunshine.  The  purity  and  simplicity  of  Indian 
habits,  however,  is  somewhat  mythical.  Their  lives  were  full  of 
hardship  and  exposure  and  their  camps  insanitary  in  all  respects. 
Their  sleeping  quarters  were  close,  foul  and  crowded  to  excess, 
and  every  condition  existed  favorable  to  the  spread  of  tubercu- 
losis.    Whatever  the  conditions  prior  to  white  settlement  may 


<j>  ^T^^^^T^^nr^T^^"^ 


FOR   THE   INVESTIGATION    OF   TUBERCULOSIS.  5 

have  been,  it  is  known  that  the  disease  was  fearfully  and  increas- 
ingly prevalent  among  the  early  New  England  communities,  and 
from  the  settlement  of  the  Colonies  up  to  modern  times  no  disease 
has  been  more  destructive. 

Reliable  registration  of  the  causes  of  death  is  of  very  recent 
establishment  everywhere.  In  Connecticut,  statistics  bearing 
upon  the  subject  are  available  for  the  period  from  1849  to  the 
present  time.  Through  the  courtesy  of  Dr.  Joseph  H.  Townsend, 
Secretary  of  the  State  Board  of  Health,  the  Commission  has 
received  the  accompanying  table  illustrating  the  tuberculosis  death 
rate  and  the  general  mortality  since  1849.  A  careful  study  of  this 
table  discloses  many  facts  of  interest.  The  most  striking  fact  is 
the  marked  decrease  that  is  shown  in  the  tuberculosis  death  rate — 
somewhat  irregular  until  1882,  but  steady  and  impressive  since 
that  year.  It  was  in  1882  that  Professor  Koch  published  his  dis- 
covery of  the  bacillus  which  is  the  universally  accepted  cause  of 
tuberculosis.  Prior  to  that  date,  the  conception  of  the  nature  of 
the  disease  was  unscientific,  and  whatever  may  have  been  done  in 
effort  toward  social  betterment  that  could  have  influenced  the 
mortality  from  tuberculosis  to  the  extent  shown  in  the  table  was, 
certainly  to  a  large  degree,  accidental.'  Since  1882,  with  the 
knowledge  of  the  cause  of  tuberculosis  based  upon  unquestioned 
scientific  demonstrations,  the  movement  for  the  control  and  ulti- 
mate eradication  of  the  disease  has  been  steadily  growing  all  over 
the  civilized  world.  The  character  of  the  disease  being  now  under- 
stood, the  effects  toward  control  can  be  intelligently  planned  and 
executed. 

The  impression  that  tuberculosis  is  constantly  increasing  and 
becoming  more  destructive  is  erroneous.  The  accompanying 
table  shows  beyond  question  the  general  trend  of  the  disease  in 
Connecticut,  and  it  is  a  matter  of  great  interest  that  the  records 
of  Maine,  New  Hampshire,  Vermont,  Massachusetts,  and  Rhode 
Island  show  a  corresponding  decrease. 

All  records  of  mortality  are  unreliable.  The  elements  of  care- 
lessness, ignorance  and  willful  misrepresentation  upon  the  part  of 
the  reporting  physicians,  cannot  be  measured  or  controlled. 
Unintentional  inaccuracy  in  diagnosis  may  change  the  tubercu- 
losis record  very  materially,  bronchitis,  pneumonia,  pleurisy,  and 
even  typhoid  fever  being  entered  as  the  cause  of  death,  when,  in 
fact,  it  should  have  been  reported  as  tuberculosis.     These  inac- 


6  REPORT   OF   THE    COMMISSION 

curacies,  in  all  records  of  the  character  under  consideration,  are 
universally  recognized  as  unavoidable.  There  is,  however,  no 
reason  to  expect  more  inaccuracy  in  one  state  than  in  another,  and 
the  very  close  correspondence  in  the  records  of  the  New  England 
states  speaks  for  their  accuracy.  The  average  tuberculosis  death 
rate  for  the  past  five  years  in  Connecticut  has  been  14.3  per  10,000 
population.  In  the  other  states  mentioned  the  figures  vary  from 
13.5  to  15.5  per  10,000,  a  very  close  correspondence,  when  due 
allowance  is  made  for  variation  in  the  methods  of  reporting. 
Another  remarkable  fact  connected  with  the  Connecticut  record 
is,  that  it  corresponds  very  closely  to  the  now  famous  table,  pub- 
lished last  winter  in  Dr.  H.  Timbrel  Bulstrode's  English  Govern- 
mental "Report  on  Sanatoria  for  Consumptives  and  certain  other 
aspects  of  the  Tuberculosis  Question."  In  Dr.  Bulstrode's  table, 
it  is  shown  that  the  phthisis  death  rate  for  England  and  Wales  fell 
steadily  from  27  per  10,000  living  in  185 1  to  12  per  10,000  living 
in  1904,  the  decline  in  Connecticut  for  the  period  from  1849  to 
1904,  as  shown  in  the  table,  being  from  27  to  14. 

When  the  tables  of  mortality  from  tuberculosis,  taken  from 
sources  so  widely  separated,  show  such  a  marked  decrease,  and 
that,  too,  to  no  inconsiderable  degree  prior  to  the  discovery  of  the 
bacillus,  the  question  as  to  the  cause  of  the  decrease  is  of  exceed- 
ing interest. 

Your  Commission  would  wish  to  emphasize  the  fact  that  the 
decrease  of  the  disease  in  Connecticut  within  the  past  fifty  years 
constitutes  the  most  hopeful  outlook  for  the  future.  It  fully 
justifies  the  State  in  every  efifort  to  control  tuberculosis,  by 
rectifying  all  such  social  abuses  as  are  now  known  to  be  most 
favorable  to  its  continuance. 

It  is  further  to  be  understood,  that  the  extremely  favorable 
reports  as  to  the  decrease  of  tuberculosis  in  our  State  are  not  to 
be  taken  as  evidence  of  a  common  experience  in  all  parts  of  the 
world.  While  England  shows  a  decrease  of  fifty  per  cent,  or 
more,  there  is  a  considerable  increase  during  the  same  period  to 
the  credit  of  Ireland.  In  France  there  is  no  such  encouraging 
condition  as  we  can  claim,  and  so  throughout  the  world,  the 
decrease  is  showing  an  irregularity  that  is  of  great  interest. 
The  knowledge  of  the  cause  of  tuberculosis,  while  it  has 
materially  afifected  the  returns  of  mortality  since  1882,  cannot  be 
accepted  as  the  sole  cause  of  the  improved  conditions  in  our  State. 


FOR   THE    INVESTIGATION    OF   TUBERCULOSIS.  7 

The  table  shows  a  decHne  from  1849  to  1882.  The  same  is  true 
of  New  England  and  England  and  Wales.  In  Connecticut,  then, 
there  has  been  some  influence  that  has  been  quietly  working 
toward  that  most  beneficent  result — the  control  of  tuberculosis. 
Where  is  that  influence  to  be  found?  In  Connecticut,  it  is 
unquestionably  a  result  of  the  movement  toward  the  general 
improvement  in  social  conditions  that  has  steadily  gained  a  foot- 
hold, in  spite  of  the  opposition  of  those  who  were  to  be  most  bene- 
fited. It  is  well  understood  that  tuberculosis  finds  its  most 
favorable  field  among  insanitary  surroundings.  This  being 
admitted,  what  argument  would  there  be  for  the  State  to  under- 
take measures  for  its  eradication  if  it  was  increasing.  Improved 
tenements,  the  regulation  of  child  labor,  sanitary  science  applied 
to  the  improvement  of  cities  and  towns — imperfectly,  to  be  sure, 
but  far  better  than  in  the  past — shorter  hours  of  labor  in  better 
ventilated  shops,  the  uplifting  eft'ect  of  a  higher  and  broader 
education,  the  education  of  the  public  into  a  reasonable  attitude 
to\yard  fresh  air  and  sunshine — all  of  these  influences  have  been 
gradually  developing  and  becoming  the  accepted  order  of  life 
during  the  last  half  century.  While  until  very  recently  efforts 
toward  an  improvement  in  social  conditions  were  inaugurated 
without  thought  of  tuberculosis,  it  is  interesting  to  note  that  there 
has  been  a  coincident  decrease  in  the  mortality  from  consumption. 
This  helps  to  establish  the  claim,  that  all  undesirable  social  condi- 
tions are  powerful  factors  in  the  causation  of  consumption.  It 
oft'ers  encouragement  for  a  broader  effort  to  secure  to  the  public 
the  best  possible  conditions  of  living.  The  State,  in  all  its  efforts 
to  secure  the  improvement  of  social  conditions,  is  incidentally 
looking  toward  the  control  of  tuberculosis. 


REPORT   OF   THE    COMMISSION 


TUBERCULOSIS— A   CONTAGIOUS   DISEASE. 


The  time  is  certainly  at  hand  for  the  education  of  the  pubHc 
everywhere,  upon  all  questions  that  may  lead  to  a  better  under- 
standing as  to  their  individual  responsibility  in  rendering  assist- 
ance in  promoting  the  success  of  the  movement  to  control 
tuberculosis.  Private  organizations  and  isolated  communities 
that  have  during  the  past  few  years  undertaken  this  work,  have 
felt  that  the  only  possibility  of  success  rested  upon  universal  educa- 
tion of  the  public  as  to  the  danger  and  its  consequences.  It  has 
been  their  effort  to  publish  broadcast,  through  every  possible 
agency,  a  statement  of  the  great  prevalence  of  tuberculosis,  the  ease 
with  which  it  may  be  disseminated  and  the  disastrous  results  that 
follow  in  its  course.  It  may  possibly  seem  ungracious  to  criticise 
work  of  this  character  that  has  been  done  and  is  now  being  done 
with  the  best  possible  motive.  There  has  been,  in  some  instances, 
an  exaggeration  of  statement  that  has  been  unfortunate  in  its 
effect  upon  those  suffering  from  tuberculosis.  It  should  be  under- 
stood, that  the  great  work  in  hand  contemplates  the  arrest  and  the 
ultimate  control  of  a  chronic  disease,  that  does  not  interfere  with 
the  daily  habits  of  life  in  some  instances  for  months  and  even 
years.  Care  should  be  exercised  not  to  arouse  the  public  alarm  to 
such  an  extent  as  to  seriously  interfere  with  the  rights  of  the  inno- 
cent sufferer.  The  public  should  be  made  fully  cognizant  of  all 
the  essential  facts  to  insure  rational  effort  to  avoid  this  disease.  It 
should  also  be  clearly  understood,  that  the  unfortunate  sufferer  is 
not  a  leper — not  one  to  be  avoided  in  daily  life,  if  he  learns  fully 
his  duty  to  himself  and  to  society  and  is  faithful  in  its  perform- 
ance. In  some  instances,  this  anxiety  upon  the  part  of  the  public 
has  been  so  acute  that  serious  suffering  has  ensued.  This  has  in 
some  localities  led  to  a  concealment  of  the  disease  by  patient  and 
physician,  a  result  to  be  most  seriously  deplored  by  all  who  desire 
success  in  the  undertaking  under  discussion. 

This  contagious  element  in  the  tuberculosis  question  has 
become  of  the  highest  importance.     The  whole  question  of  con- 


FOR   THE    INVESTIGATION    OF    TUBERCULOSIS.  9 

tagion — of  the  method  of  transmission  of  any  disease  from  man 
to  man — is  most  imperfectly  understood.  Within  a  very  few 
years,  yellow  fever  was  supposed  to  be  air-borne,  one  of  the  most 
highly  contagious  diseases.  Malaria  was  long  supposed  to  be 
water-borne  and  intimately  associated  with  the  upturning  of  the 
soil.  The  fact  that  both  of  these  diseases  are  now  known  to  be 
transmitted  by  inoculation  only ;  that  attendants  of  yellow  fever 
patients  are  free  from  all  danger,  so  long  as  they  are  not  infected 
by  the  mosquito ;  that  the  most  pernicious  malaria  can  be  avoided 
by  an  efficient  mosquito  bar,  in  places  that  were  previously  almost 
uninhabitable,  must  lead  anyone  studying  the  contagious  element 
in  tuberculosis  to  hesitate  before  expressing  a  positive  opinion 
upon  the  matter.  It  can  be  stated  with  confidence  that  tubercu- 
losis, under  proper  sanitary  precautions,  cannot  be  easily  trans- 
mitted from  man  to  man.  If  it  possesses  any  contagious  quality, 
it  is  not  in  the  sense  in  which  that  word  is  commonly  used  in 
speaking  of  scarletina,  measles,  smallpox  and  such  highly  con- 
tagious diseases.  Dr.  Hermann  Biggs  of  New  York  City,  a 
pioneer  in  all  good  work  for  the  municipal  control  of  tuberculosis, 
says :  "It  seems  to  me  that  the  difficulties  in  dealing  with  the 
disease  have  been  greatly  increased,  because  of  the  failure  of  sani- 
tary authorities  generally  to  recognize  this  distinction.  Both  to 
the  public  and  to  the  medical  profession  the  term  'contagious' 
conveys,  a  distinct  conception  of  the  ready  transmissibility  of 
disease  from  the  sick  to  the  well  after  slight  exposure.  This  is 
certainly  not  true  of  tuberculosis."  Since  the  general  public  has 
become  aroused  as  to  the  importance  of  intelligent  measures  to 
control  the  spread  of  tuberculosis,  the  contagious  quality  of  the 
disease  has  been  most  injudiciously  emphasized,  and  in  conse- 
quence, an  increasing  fear  of  the  unfortunate  sufferers  from  the 
disease  created. 

It  has  been  scientifically  demonstrated,  that  under  proper  con- 
ditions, attendance  and  even  constant  attendance  upon  tubercu- 
losis patients  is  not  attended  with  danger.  The  sanatoria  in  all 
parts  of  the  world  report  that  their  attendants  of  all  classes 
remain  free  from  the  disease.  If  tuberculosis  were  air-borne  and 
highly  contagious  to  the  degree  that  we  suppose  the  acute  con- 
tagious diseases  to  be,  such  a  report  would  be  impossible.  Dr. 
Bulstrode,  in  his  report  previously  quoted,  gives  many  instances  in 
support  of  the  low  degree  of  contagion  in  tuberculosis  and  to 


lO  REPORT   OF   THE    COMMISSI© iS^ 

its  innocuousness  under  proper  sanitary  regulations.  A  few 
quotations  will  be  of  interest. 

"At  Falkenstein  during-  lo  years  225  non-tuberculous  friends 
accompanying  patients  have  stayed  at  the  sanatorium — many  have 
stayed  for  six  months  and  no  case  of  infection  has  been  observed." 

"At  Goebersdorf,  where  during  40  years  25,000  tuberculous 
patients  have  been  treated  in  the  sanatoria,  pulmonary  tuberculosis 
among  the  inhabitants  in  the  village — notwithstanding  the  fact 
that  during  the  last  30  years  the  population  has  nearly  doubled — 
has  according  to  the  figures  published  by  Dr.  Nahon  apparently 
decreased."  This  is  shown  in  the  accompanying  table  copied 
from  Dr.  Bulstrode. 

Deaths 
from 
Years.  Tuberculosis. 

1856-1859  7 

1866-1869 4 

1870-1879  5 

1880-1889  5 

1890-1897  3 

"In  the  village  of  Falkenstein  before  the  sanatorium  was 
opened  the  mortality  from  tuberculosis  was  18.9- 100  deaths,  while 
since  the  opening — from  1877  to  1894: — it  has  fallen  to  11.9  per 
cent." 

As  regards  our  own  country,  the  experience  of  Dr.  E.  L. 
Trudeau,  in  his  world  famous  sanatorium  at  Saranac  Lake,  N.  Y., 
corresponds  with  the  German  institution  mentioned  above.  There 
has  not  been  a  case  of  infection  among  all  the  doctors  and  other 
attendants  who  have  served  the  Saranac  institution  since  its 
opening. 

It  is  to  be  understood  that  this  association,  without  harm,  with 
the  tuberculous,  is  invariably  where  the  restrictions  upon  the 
habits  of  the  patient,  now  so  universally  advocated,  have  been 
faithfully  observed.  It  is  known  beyond  controversy  that  tuber- 
culosis— consumption  as  it  is  commonly  called — is  caused  by  a 
specific  germ  known  as  the  tubercle  bacillus. 

Without  the  presence  of  this  germ  the  disease  does  not  exist. 
The  common  belief  that  consumption  is  usually  the  result  of 
"a  cold,"  of  being  overworked,  mentally  or  physically,  of  being 
depressed  physically  because  of  poverty  or  prolonged  exposure, 
is  not  accurate.     The  germ  of  the  disease  is  about  us  everywhere. 


FOR   THE   INVESTIGATION   OF   TUBERCULOSIS.  II 

To  those  in  sound  physical  condition  it  is  apparently  harmless. 
In  those  who  are  ill  and  below  the  safe  point  of  resistance,  the 
germ  finds  a  favorable  soil  and  develops.  The  victim  must  in 
some  way  receive  this  germ  directly  or  indirectly  from  an  active 
case.  It  is  a  matter  of  very  simple  demonstration  to  prove  that 
through  expectoration,  through  the  droplets  intimately  divided  in 
the  breath  during  coughing,  and  through  other  discharges  from 
the  body  to  a  less  degree,  the  bacillus  is  constantly  discharged  from 
those  suffering  from  tuberculosis ;  and  where  the  simple  rules  for 
decency  and  cleanliness — now  so  earnestly  advocated  and  pub- 
lished broadcast  in  every  community — are  disregarded,  the  num- 
ber of  germs  daily  thrown  into  the  air  is  innumerable.  Once  free 
from  their  host,  the  germ  soon  perishes  in  pure  air  and  sunlight; 
but  as  the  air  becomes  foul  and  damp  and  the  sunlight  is  obscured, 
the  life  and  virulence  of  the  bacillus  is  prolonged.  When  the 
bacillus  lodges  in  dark,  ill-ventilated  and  damp  lodgings,  it  can 
retain  its  virulence  for  an  indefinite  period.  This  explains  the 
fact,  that  while  tuberculosis  can  be  found  in  the  homes  of  the 
wealthy,  living  in  surroundings  that  would  seem  to  ensure  safety, 
it  is  found  in  increasing  frequency  as  the  housing  conditions 
become  poorer,  until  in  the  crowded  tenement  it  gains  a  foothold 
that  contaminates  the  house  and  renders  it  unfit  for  use.  Much 
has  been  written  of  late  about  infected  houses.  It  will  be  shown 
that  such  exist,  but  space  forbids  any  detailed  investigation  of 
this  phase  of  the  subject. 

The  two  facts  that  it  is  most  desirable  should  be  clearly  estab- 
lished in  the  minds  of  the  general  public,  if  a  reasonable  effort  to 
control  tuberculosis  is  to  succeed,  are :  First,  the  disease  known  as 
tuberculosis,  at  all  times  so  destructive  to  human  happiness  and 
hfe,  is  gradually  coming  under  control,  as  the  living  conditions 
of  society  improve.  There  is  every  reason  to  believe  that  the  day 
will  come,  if  the  measures  to  destroy  the  disease  are  systemati- 
cally enforced  by  the  State,  when  tuberculosis  will  be  under 
control.  Second,  the  sufferers  from  tuberculosis  who  are  care- 
ful as  to  their  personal  habits  and  conscientiously  observe  all  the 
rules  for  the  destruction  of  the  germ  as  it  leaves  the  body,  are  not 
a  source  of  danger  to  their  associates. 

The  effort  has  been  made,  in  writing  of  the  contagious  charac- 
ter of  tuberculosis,  to  make  it  clear  that  the  danger  of  contagion 
is  very  slight   from   association   with  those  suffering   from  the 


\ 

12  REPORT   OF   THE    COMMISSION 

disease,  when  due  precautions  as  to  cleanliness  are  observed  and 
when  the  patient  is  in  such  physical  condition  as  to  admit  of  free 
social  intercourse.  When  the  patient  has  become  so  ill  as  to 
require  personal  attendance,  it  become  a  very  difficult  matter  to 
avoid  occasional  acts  of  thoughtlessness  through  which  the  sputum 
may  be  scattered,  and  at  such  times  the  danger  of  contagion  is 
imminent.  When  the  sufferer  is  careless,  no  matter  in  what 
stage  of  the  disease  he  may  be,  he  is  a  constant  and  positive 
source  of  danger.  He  is  much  more  dangerous  to  the  community 
than  a  patient  suffering  from  an  acute  contagious  disease — a  fact 
that  justifies  including  tuberculosis  among  contagious  diseases. 


FOR   THE    INVESTIGATION    OF   TUBERCULOSIS.  1 3 


WHAT  IS  THE  STATE'S  DUTY? 


The  efforts  that  have  been  made  during  the  past  few  years  to 
control  the  acute  contagious  diseases,  have  at  last  met  v^ith  public 
approval,  and  no  opposition  is  felt  to  reasonable  supervision  upon 
the  part  of  the  health  authorities.  Until  very  recently,  the  feeling 
toward  the  official  supervision  of  tuberculosis  has  been  inclined  to 
be  hostile.  The  character  of  the  disease,  its  insidious  develop- 
ment, the  popular  belief  that  it  must  necessarily  prove  fatal,  has 
led  to  a  feeling  of  scepticism  as  to  the  methods  proposed  for  its 
relief.  This  scepticism  has  now  very  generally  yielded  to  a  belief 
in  the  possibility  of  cure,  and  the  day  is  at  hand  when  all  reason- 
able measures  that  the  State  may  adopt  for  the  control  of  tuber- 
culosis will  meet  with  sympathy.  What,  then,  is  the  duty  of  the 
State?  The  essentials  of  success  are,  first,  measures  to  avert  the 
development  of  the  disease ;  and  second,  the  systematic  care  of  all 
sufferers  who  may  be  unable  to  secure  suitable  care  during  their 
enforced  idleness. 

Measures  to  control  the  development  of  tuberculosis  include : 

1.  Notification  and  registration  of  all  cases  of  tuberculosis  in 
every  community. 

2.  Control  of  indiscriminate  expectoration. 

3.  Rational  tenement  house  legislation,  embracing  construc- 
tion and  subsequent  inspection. 

4.  Sanitary  supervision  of  all  buildings  where  people  are 
brought  into  intimate  association. 

5.  Scientific  supervision  of  the  dairy  and  food  industries. 

6.  Intelligent  efforts  to  educate  the  public  as  to  proper  sani- 
tary precautions. 

All  of  these  measures  are  essential  to  success  in  securing  the 
control  of  tuberculosis.  It  is  of  interest  and  importance,  in  seek- 
ing state  action  upon  the  various  measures  toward  the  control 
of  tuberculosis,  to  emphasize  the  fact  that  all  other  efforts  toward 
the  social  betterment  of  the  community  have  a  common  interest. 
These  various  measures,  intelligently  enforced,  would  be  of  the 
highest  possible  social  and  economic  value  to  the  whole  State. 


14  REPORT   OF    THE    COMMISSION 


THE  NOTIFICATION  AND  REGISTRATION 
OF  TUBERCULOSIS. 


If  a  scientific  effort  is  to  be  made  by  the  State  to  control  the 
disease  in  question,  it  is  obvious  that  no  proper  estimate  of  the 
value  of  the  effort  can  be  secured,  unless  it  is  based  upon  accurate 
statistical  records.  No  information  as  to  the  extent  of  tubercu- 
losis can  be  obtained  by  any  other  method  than  notification,  such 
as  is  now  required  in  the  acute  contagious  diseases.  In  attempt- 
ing to  secure  an  accurate  registration  of  all  cases  of  this  disease, 
no  interference  with  the  rights  or  liberty  of  the  patient  is  con- 
templated. Among  all  those  patients  who  are  in  position  to  meet 
the  cost  of  treatment,  the  act  of  registration  does  not  go  beyond  a 
confidential  record  of  the  case  with  the  proper  health  officer.  A 
record  of  those  who  are  unable  to  meet  the  cost  of  treatment  is 
of  undoubted  value,  in  bringing  to  official  knowledge  the  extent 
and  character  of  relief  work  that  may  be  required.  The  opposi- 
tion to  notification  of  tuberculosis  has  been  very  active,  wherever 
it  has  been  attempted,  and  the  most  active  in  the  opposition  have 
been  the  physicians.  There  seems  to  be  an  impression  that  in 
some  way  notification  is  violation  of  professional  confidence. 
Certainly  a  report  to  the  local  health  officer,  accompanied  by  a 
statement  that  the  case  is  under  suitable  treatment,  is  not  making 
public  the  patient's  condition.  Such  an  official  record  is  a  confi- 
dential communication  and  any  violation  of  confidence  upon  the 
part  of  the  health  officer  should  be  actionable.  The  cases  not 
requiring  official  supervision,  in  the  states  where  notification  is 
enforced,  are  simply  enumerated  in  the  records,  showing  the 
prevalence  of  the  disease,  and  aside  from  that  have  no  publicity. 
Notification  of  the  indigent  is  of  the  first  importance.  It  is  the 
indigent  case  that  is  the  most  difficult  to  detect  and  the  most 
serious  as  a  source  of  danger  to  the  general  public.  These  cases 
must  be  discovered  and  must  be  under  official  supervision,  if  any 
good  is  to  be  accomplished.  No  concealment  of  a  tuberculous 
case  that  occupies  apartments  in  common  with  others,  is  justifi- 
able, unless  there  is  intelligence  to  understand  the  necessity  for 


FOR   THE   INVESTIGATION    OF   TUBERCULOSIS.  1 5 

precaution  and  the  means  and  inclination  to  enforce  the  same. 
Among  the  indigent,  it  should  be  left  with  the  health  officer  to 
decide  as  to  the  trustworthiness  of  individual  cases,  when  they  are 
reported. 

In  some  states  there  has  been  an  attempt  to  secure  voluntary 
notification,  but  the  results  have  been  highly  unsatisfactory. 
Even  where  notification  is  supposed  to  be  enforced,  physicians 
have  been  extremely  careless  in  complying  with  the  requirements. 
Many  deaths  from  tuberculosis  are  being  reported,  where  no 
previous  report  of  the  case  had  been  received.  Notification 
should  be  either  enforced  or  not  attempted.  There  is  little  value 
in  a  law  that  is  observed  or  not,  as  the  individual  may  prefer. 
There  is  no  value  in  inaccurate  statistics.  The  records  of  the  true 
prevalence  of  tuberculosis  in  any  state  in  the  Union  would  be  a 
source  of  surprise,  even  to  those  supposed  to  be  familiar  with  the 
situation.  The  opposition  to  notification  is,  to  a  certain  extent, 
due  to  a  lack  of  interest  in  public  measures  to  suppress  tubercu- 
losis, and  to  an  unwillingness  to  make  the  slight  exertion  required 
for  filling  and  mailing  the  report.  The  laws  for  the  control  of 
tuberculosis  in  Maryland  are  unusually  complete,  and  it  is  of 
interest  to  note  that  the  notification  of  cases  became  much  more 
satisfactory  after  the  establishment  of  a  small  registration  fee. 
Such  an  expenditure  upon  the  part  of  our  own  State  would  yield 
to  the  community  a  high  rate  of  interest,  in  its  influence  toward 
securing  an  accurate  report. 

If  it  is  understood  that  the  notification  of  tuberculosis  does  not 
place  that  disease  in  the  same  category  as  the  acute  contagious 
diseases ;  that  the  notification  is  to  be  treated  as  a  confidential 
communication  and  imposes  no  burdensome  obligation  upon 
patients,  where  the  physician  certifies  that  proper  precautions  are 
being  observed ;  when,  further,  the  fact  of  notification  being  com- 
pulsory, relieves  the  physician  from  all  responsibility  in  the  matter 
in  so  far  as  violation  of  professional  confidence  is  concerned,  the 
compliance  with  the  law  will  soon  become  customary  and  objec- 
tion to  it  will  cease. 

The  Maryland  plan  of  making  fair  payment  to  the  physician  for 
his  service,  is  eminently  proper  and  should  be  the  rule  everywhere. 
In  doing  his  part  toward  securing  reliable  records  of  tuberculosis, 
the  physician  is  rendering  a  service  of  value,  for  which  he  should 
receive  compensation. 


1 6  REPORT   OF    THE    COMMISSION 


CONTROL  OF  EXPECTORATION. 


It  has  already  been  stated  that  tuberculosis  is  a  disease  due  to 
infection,  caused  by  the  bacillus  that  has  escaped  from  someone 
already  suffering  with  the  disease.  The  chief  avenue  of  escape  is 
of  course  through  the  mouth,  either  in  the  act  of  expectoration,  or 
through  the  minute  subdivisions  (called  droplets)  that  escape 
into  the  air  in  the  act  of  coughing.  Many  people  in  every  com- 
munity have  tuberculosis  long  before  they  are  conscious  of  the 
fact;  often  cases  recover  without  the  patient  having  even  sus- 
pected that  he  was  tuberculous.  No  man  can  say  that  there  is  no 
danger  in  his  sputum.  That  indiscriminate  expectoration  is  the 
chief  source  of  a  disease,  so  serious  in  its  consequences  as  to 
justify  large  expenditure  upon  the  part  of  the  State  to  eradicate 
it,  is  a  fact  worthy  of  thoughtful  consideration. 

Why  should  men  expectorate  broadcast  over  the  land,  if  in  so 
doing  they  are  often  casting  out  the  germ  that  is  to  bring  misery 
and  want,  maybe,  to  many  an  industrious  and  worthy  neighbor? 
This  is  not  extravagance :  it  is  simply  truth.  Why  should  people 
spit  in  an  unsuitable  place  ?  Why  should  they  cough  directly  into 
the  air  of  any  room  they  may  happen  to  be  in?  In  this  whole 
question  of  the  control  of  tuberculosis  there  is  much  still  to  be 
carefully  considered.  There  are  many  questions  justly  open  to 
discussion.  As  to  this  promiscuous  spitting,  there  is  not  the 
faintest  shadow  of  a  question — it  is  indescribably  filthy  and  offen- 
sive, is  dangerous  to  others,  is  unnecessary  and  should  be  stopped. 
The  efforts  made  during  the  past  few  years  to  check  this  unmiti- 
gated nuisance  have  been  followed  by  very  considerable  improve- 
ment. In  most  of  our  cities,  the  sidewalks  are  comparatively 
clean  and  do  not  call  for  that  care  upon  the  part  of  the  pedestrian 
that  was  formerly  required.  So  much  accomplished  is  a  cause 
for  some  satisfaction,  but  the  public  should  understand  that 
offense  in  this  matter  does  not  begin  and  end  on  the  sidewalk. 
The  greatest  source  of  danger  is  in  the  shops,  the  schools,  the 
churches,  in  all  places  where  people  usually  congregate.     How 


FOR   THE   INVESTIGATION    OF   TUBERCULOSIS.  1 7 

long  suffering,  to  say  nothing  of  the  exposure  to  tuberculosis,  are 
those  who  are  obliged  to  find  their  solace  in  the  average  smoking 
car.  It  is  a  very  simple  matter  to  rectify  all  this  abuse  of  the 
public.  If  certain  people  must  expectorate,  suitable  receptacles 
should  be  provided  and  they  should  be  properly  cleansed.  An 
effort  to  correct  this  evil  has  been  made  by  many  of  the  prominent 
manufacturers  of  the  State.  In  some  of  our  shops  to-day,  instead 
of  walls  and  floor  unspeakably  foul,  one  sees  clean  surfaces,  free 
from  all  objectionable  matter.  That  this  is  a  great  movement 
toward  the  improvement  of  the  health  of  the  employees,  is  certain. 
When  the  movement  is  universal  and  especially  when  the  people 
themselves  won't  allow  promiscuous  expectoration,  then  assuredly 
one  great  step  forward  will  have  been  made,  toward  the  control  of 
tuberculosis. 


l8  REPORT   OF   THE    COMMISSION 


THE  HOUSING  PROBLEM. 


Early  in  the  development  of  interest  in  the  question  of  state 
control  of  tuberculosis,  systematic  investigation  of  the  tenement 
house  conditions  in  crowded  centers  of  population  attracted 
special  attention.  Tuberculosis  was  known  to  be  a  disease  that 
was  specially  frequent  and  virulent  in  crowded  habitations 
occupied  by  the  extremely  poor  and  ignorant.  The  excess  of 
population  was  not  alone  responsible  for  the  difficulty.  The 
associated  poverty  and  neglect  of  sanitary  rules  of  conduct  were 
equally  potent  factors.  The  conditions  that  have  been  revealed  in 
New  York  City,  Philadelphia,  Chicago,  and  in  fact  all  the  great 
cities  of  the  world,  are  appalling.  Charts  of  the  infected  districts 
in  those  cities  have  been  published,  showing  some  portions  of  the 
poorest  quarters  so  seriously  infected  as  to  justify  the  question 
whether  any  of  the  occupants  of  such  homes  escape  some  degree 
of  infection.  In  Connecticut  we  have  no  great  cities.  In  the 
neighborhood  of  the  largest  cities  that  we  have,  within  a  few 
minutes'  walk  of  the  centers  of  work,  are  open  fields,  ready  for 
occupation  and  to  be  purchased  at  reasonable  price.  Such  being 
the  case  and  with  trolley  development  rendering  even  more  dis- 
tant and  more  healthful  localities  easily  within  reach,  the  develop- 
ment of  the  unhygienic  tenement  is  not  a  necessit}^  and  the 
growth  of  the  nuisance  is  to  be  deplored. 

And  yet  in  most  of  our  cities,  with  apparently  little  necessity  for 
overcrowding  and  unhygienic  living,  the  evil  of  the  tenement 
house  is  undoubtedly  rapidly  increasing.  Under  present  condi- 
tions, this  state  of  affairs  seems  to  be  unavoidable,  for  two 
reasons :  First,  the  cheaply  built,  overcrowded  tenement  is  a 
profitable  investment  and  the  owners  of  property,  who  look  only 
for  large  returns,  have  a  legal  right  to  construct  such  buildings, 
if  they  comply  with  the  building  regulations  that  are  specified  in 
the  laws  for  tenement  construction.  These  tenement  hou=:e 
owners  form  a  class  in  every  city  that  are  active  in  maintaining 
their  right  to  erect  such  buildings,  and  are  a  political  factor  that 


FOR   THE    INVESTIGATION    OF   TUBERCULOSIS.  19 

cannot  be  disregarded.  Second,  most  of  the  people  who  occupy 
these  tenements  are  contented  with  their  accommodations  and  are 
not  in  sympathy  with  the  measures  that  enHghtened  members  of 
every  community  have  earnestly  advocated  on  their  behalf.  The 
vast  immigration  to  our  country,  that  pours  into  every  city  and 
town  annually,  thousands  of  the  poorest  from  the  countries  of 
Southern  and  Southeastern  Europe  and  from  the  far  East,  has 
created  a  new  order  of  things  in  our  municipal  life.  These  people 
have  left  conditions  much  worse  than  they  find  them  here.  The 
tenement  that  to  the  educated  American  seems  insufferable,  is  to 
these  immigrants  superior  to  what  they  have  left.  They  are 
often  densely  ignorant  and  prejudiced  against  all  measures  for 
their  relief,  regarding  with  suspicion  the  efforts  of  social 
reformers,  whose  motives  they  are  incapable  of  understanding. 
These  immigrants  are  not  only  content  with  the  crowded  tene- 
ment, but  to  a  large  degree  they  enjoy  the  life  that  brings  them 
into  close  association  with  so  many  of  their  own  class.  They  will 
endure  privation  and  impaired  health  willingly,  rather  than  accept 
employment  iri  the  open  country,  where  they  can  receive  good 
wages  and  clean  and. healthful  homes.  Many  of  these  immigrants 
are  industrious  and  thrifty,  and  prefer  the  cheapest  rent  pos- 
sible to  enable  them  to  accumulate  money.  As  they  become 
accustomed  to  the  new  country  and  have  saved  sufficient  to  admit 
of  living  under  better  conditions,  they  move  into  homes  of  their' 
own,  or  into  tenements  of  a  better  class.  The  places  that  they 
leave  vacant  are  immediately  filled  by  the  endless  supply  that 
comes  from  the  home  country,  and  their  early  experiences  in 
America  are  repeated.  The  proper  regulation  of  the  tenements 
occupied  by  this  class  must  ever  rest  with  the  local  health  authori- 
ties. These  tenements  are  sure  to  become  foci  of  infection  that 
are  a  serious  menace  to  the  public  health,  if  they  are  not  kept 
under  rigid  supervision.  This  condition  of  affairs,  that  seriously 
complicates  all  effort  toward  hygienic  living,  seems  to  be  destined 
to  continue  indefinitely.  There  is  no  reason  to  suppose  that  the 
attitude  of  these  foreigners  toward  sanitary  precautions  will  ever 
be  changed  from  what  it  is  to-day.  The  health  authorities  must 
ever  be  on  the  alert  to  suppress  all  vicious  practices  and  thus  keep 
these  tenements  in  a  condition  as  little  prejudicial  to  the  public 
welfare  as  may  be  possible. 


20  REPORT   OF   THE    COMMISSION 

The  greatest  influence  that  can  be  brought  to  bear  upon  this 
class  of  the  community  is  in  the  education  of  the  children. 
Every  child  should  be  educated  in  the  rules  of  decent  living,  and 
in  such  rules  for  the  avoidance  of  practices  that  lead  to  sickness 
as  they  may  be  old  enough  to  comprehend.  Our  public  educators 
have  it  in  their  power  to  do  more  than  any  other  organization  to 
accustom  the  children  of  our  cities  and  towns  to  an  apprecia- 
tion of  the  value  of  fresh  air,  clean  food,  decent  sanitary  pre- 
cautions. Children  can  be  made  to  accept  all  such  ideas  and  to 
influence  their  parents  in  observing  them.  If  tuberculosis  is  to 
be  controlled,  a  large  part  of  the  influence  that  is  to  bring  about 
that  beneficent  result  will  come  from  judicious  public  school 
instruction. 

Another  evil  is  rapidly  developing  in  our  cities  that  calls  for 
special  attention.  The  lodging-house  is  an  institution  that  seems 
some  degrees  lower  than  the  tenement.  A  house  so  old  that  it 
would  better  give  place  to  a  newer  and  more  suitable  structure,  is 
purchased  for  a  very  small  sum  and  filled  with  beds  and  bunks 
to  its  utmost  capacity.  The  occupants  have  no  decent  means  for 
personal  cleanliness,  and  it  is  to  be  feared  that  in  the  majority  of 
cases  they  are  not  disturbed  by  that  fact.  In  such  houses  the 
floating  and  extremely  poor  congregate.  They  are  the  beings  most 
of  all  likely  to  be  tuberculous,  least  of  all  likely  to  take  the  slightest 
precautions,  or  to  receive  kindly  the  suggestions  of  workers 
devoted  to  improving  their  conditions.  To  add  to  the  undesir- 
able characteristics  of  this  lodging-house  class,  they  are  a  floating 
population — fifteen  cents  a  night  for  a  bed,  no  matter  where  the 
bed  is — in  one  part  of  the  town  one  night,  in  another  part  the 
night  following.  So  they  roam  about  and  scatter  the  germs  of 
tuberculosis,  with  an  industry  that  most  of  them  are  not  in  the 
habit  of  displaying  in  other  directions.  The  occupants  of  lodg- 
ing-houses are  an  indolent,  undesirable  class,  upon  the  one  hand  ; 
or  a  very  poor  class,  who  are  soon  to  occupy  better  accommoda- 
tions, as  they  find  work  and  are  enabled  to  better  their  condition. 
That  the  indolent  should  be  restrained  from  becoming  a  serious 
menace  to  the  public  welfare,  is  right ;  it  is  equally  right  that 
careful  inspection  and  regulation  of  these  lodging-houses  should 
render  them  as  little  harmful  as  possible,  in  the  interest  of  the 
worthy  who  are  for  the  time  being  compelled  to  occupy  them. 
The  profits  that  come  to  the  owners  of  low  tenements  and  lodg- 


\s 


iN-d-REASL    IN   POPUSAT/Oy  If^ 

7i/BE^uioi!S  -Death  Rcss  24  f- 


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FOR   THE   INVESTIGATION    OF   TUBERCULOSIS.  2  1 

ing-houses  are  relatively  large.  In  all  efforts  to  secure  proper 
supervision  of  the  business,  these  owners  are  found  to  be 
financially  able  to  maintain  an  opposition  that  is  not  easily  over- 
come. They  have  no  interest  beyond  the  return  that  they  may 
get  for  their  investment.  It  has  already  been  shown,  that  the 
unfortunate  occupants  of  their  houses  are,  as  a  rule,  wholly  indif- 
ferent to  any  measures  for  their  physical  betterment.  Why  then 
do  we  not  let  them  alone  ?  Because  it  is  the  State's  duty  to  do  the 
best  by  every  man,  even  when  in  his  ignorance  he  scorns  the 
effort,  and  because,  in  the  foci  of  infection  that  are  being  estab- 
lished by  these  undesirable  agencies,  the  well-being  of  the  whole 
community  is  being  jeopardized. 

It  is  within  the  power  of  the  Commission  to  publish  charts  of 
local  conditions  in  our  cities  that  would  fully  confirm  what  has 
been  written  upon  the  subject,  but  it  is  deemed  wiser  to  avoid  any 
specific  exposure  of  the  evils  in  question.  The  facts  are  known. 
The  health  authorities  of  our  cities  are  fully  cognizant  of  the 
truth.  It  is  for  them  to  act  and  for  the  State  to  stand  back  of 
them  and  further  their  efforts. 

So  much  has  been  written  of  infected  districts  in  our  cities,  that 
there  seems  to  be  a  popular  impression  that  tuberculosis  is  a  city 
disease.  Is  this  so  ?  Has  the  farmer  no  interest  in  the  question, 
because  of  his  security  from  infection?  To  answer  this  ques- 
tion, your  Commission  has  taken  measures  to  investigate  tubercu- 
losis in  rural  Connecticut,  exclusive  of  the  cities. 

The  State  of  Connecticut  has  on  an  average  about  200  people 
to  the  square  mile.  New  Haven  County  has  488  to  the  square 
mile;  Hartford  County,  324;  Middlesex  County,  114;  Windham 
County,  92;  Fairfield  County,  314;  New  London  County,  126; 
Litchfield  County,  73 ;   Tolland  County,  58. 

During  the  past  ten  years  the  population  of  Connecticut  has 
increased  about  20  per  cent.  The  population  of  New  Haven 
County  has  increased  about  22  per  cent. ;  Hartford  County,  32 
per  cent.;  Fairfield  County,  18  per  cent.;  New  London  County, 
6  per  cent. ;  Litchfield  County,  16  per  cent.,  while  the  population 
of  Tolland  County  has  decreased  6  per  cent. 

In  the  statistical  year  1905-1906,  the  death  rate  from  tubercu- 
losis of  all  kinds  in  the  different  counties  was  as  follows :  New 
Haven,  15  per  10,000;  Hartford,  16;  Fairfield,  19;  New  London, 
16;    Middlesex,  24;   Windham,  17;    Litchfield,  14;    Tolland,  12. 


REPORT   OF   THE    COMMISSION 


The  death  rate  in  the  ten  largest  cities  of  the  State  was  as 
follows : 

Tuberculosis  death 
City.  Population.  rate  per  10,000. 

New  Haven  121,216  18  per  10,000 

Hartford  95,822  16  per  10,000 

Bridgeport 84,274  21  per  10,000 

Waterbury 61,900  15  per  10,000 

New  Britain 33,720  15  per  10,000 

Meriden 30,658  16  per  10,000 

Norwich  25,620  16  per  10,000 

Norwalk 21,243  16  per  10,000 

Stamford 20,720  16  per  10,000 

New  London  19,822  16  per  10,000 

These  figures  do  not  represent  an  exceptional  year.  They  are 
approximately  representative  of  the  statistics  from  the  different 
counties  for  the  past  ten  years  as  may  be  seen  by  consulting  the 
appended  tables. 

COUNTY   OF   NEW   HAVEN.' 
1894-1906. 

Estimated  Total  Deaths  from      Deaths  from 

Population.  Deaths.        Tuberculosis.        Phthisis. 

1894-95 236,662  4,017  503  429 

1895-96 236,662  4,232  491  417 

i896-'97 254,605  4.525  470  391 

1897-98 ,     259,550  4,067  481  404 

i898-'99 263,528  4,318      .  515  466 

i899-'oo 274,375  4,153  486  437 

i900-'oi 269,163  4,773             .  543  484 

1901-02 269,163  4,451  498  446 

1902-03 281,162  4,371  500  450 

1903-04 287,209  4,549  489  417 

1904-05 293,200  4,620  510  443 

1905-06 299,225  4,848  470  427 

No.  of  deaths  No.  of  deaths 

No.  of  deaths  to  fromT.B.  to  from  Phthisis  to 

1,000  population.  1,000  population.  1,000  population. 

1894-95 16.S+  2.1+  1.8+ 

1895-96... ■ 17-3+  2.0+  1.7+ 

i89^'97........  17-7+  1-8+  1.5+ 

1897-98 15-6+  1.8+  1.5+ 

i898-'99 16.4 —  1-9+  1-8 — 

1899-00 I5-I+  1-7+  1-6 — 

i900-'oi 17-7+  2.0+  _  1.8 — 

1901-02 16.5 —  1.8+  1.6+ 

i902-'03 15.5+  1.7+  1.6+ 

i903-'04 15-8+  1.7+  1-4+ 

1904-05 157+  1-7+  1-5+ 

1905-06 14.5+  .        I.S+  1.4+ 


FOR   THE    INVESTIGATION    OF   TUBERCULOSIS. 


23 


HARTFORD    COUNTY. 
I 894-1 906. 

Estimated  Total            Deaths  from    Deaths  from 

Population.  Deaths.         Tuberculosis.       Phthisis. 

1894-95 161,725  2,560                    280  250 

1895-96 161,725  2,827                    303  264 

1896-97 172,119  2,987                    287  231 

1897-98 186,408  2,891                     358  309 

1898-99 185,858  '2,939                    308  27s 

i899-'oo 189,260  3,217               349  324 

i900-'oi 195,415  3.418                339  315 

1901-02 195.415  3,082                321  294 

1902-03 205,117  2,891                263  242 

1903-04 209,683  3,253               316  282 

1904-05 214,698  3,367               303  270 

1905-06 219,626  3,488               352  300 

No.  of  deaths  No.  of  deaths 

No.  of  deaths  to  from  T.B.  to  from  Phthisis  to 

1,000  population.  1,000  population,  1,000  population. 

1894-95 15-8+  1.7+  1-5+ 

1895-96 17-4+  1-8+  1.6+ 

i8q6-'97 17.3+  1.6+  1.3-f 

i897-'98 15.5+  I -9+  1-64- 

i898-'99 15-8+  i.6-f-  1.4+ 

i899-'oo 16.9+  i.8-f  1.7+ 

I900-'oi 17-4+  1-7+  1.6+ 

1901-02 15-2+  i.6-\-  1-54- 

1902-03 14-0+  1-2+  I-I+ 

i903-'04 15-5+  1-5+  i-34- 

1904-05 15.6+  1.4+  I.2-f- 

1905-06 15.8+  1.5+  1.3+ 


FAIRFIELD    COUNTY 
I 894-1 906. 

Estimated  Total 

Population.  Deaths. 

1894-95 166,927  2,817 

1895-96 166,927  3,069 

i896-'97 172,898  3,063 

1897-98 178,074  2,812 

i898-'99 179,070  2,807 

i899-'oo 182,395  2,892 

I900-'oi 184,203  3,220 

1901-02 184,203  3,027 

1902-03 191,014  3,088 

i903-'o4 194,440  3,269 

i904-'o5 197.848  3,328 

1905-06 201,261  3,453 


Deaths  from 
Tuberculosis. 

Deaths  from 
Phthisis. 

335 

237 

411 

291 

375 
33^ 

251 
257 

341 

307 

337 

299 

343 
369 
322 
308 

309 
330 
283 
289 

341 
386 

311 
336 

24 


REPORT   OF   THE    COMMISSION 


No.  of  deaths  to 
i,ooo  population. 

i894-'95...;....  16.8+ 

1895-96 18.3+ 

i89^'97 17-7+ 

1897-98 15.7+ 

i898-'99 15.6+ 

i899-'oo 15.3+ 

i900-'oi 174+ 

1901-02 16.4+ 

1902-03 16.1+ 

1903-04 16.8 

1904-05 16.3+ 

1905-06 17- 1+ 


No.  of  deaths 

No.  of  deaths 

from  T.B.  to 

from  Phthisis  to 

1,000  population. 

1,000  population 

2.0+ 

1.4+ 

2.4+ 

1-7+ 

2.1+ 

1.4+ 

1.8+ 

1.4+ 

1.9+ 

1-7+ 

1.8+ 

1.6+ 

1.8+ 

1.6+ 

2.0+ 

1-7+ 

1.6+ 

1.4+ 

1-5+ 

1.4+ 

1-7+ 

1-5+ 

1-9+ 

1.6+ 

LITCHFIELD   COUNTY. 


1894-1906. 


Estimated 
Population. 

1894-95 56,433 

1895-96 57,888 

i896-'97 59,229 

1897-98 60,123 

1898-99 62,572 

i899-'oo 62,764 

i900-'oi 63,672 

1901-02 63,672 

1902-03 65,696 

1903-04 66,712 

1904-05 (iTil^T- 

i90S-'o6 68,735 


No.  of  deaths  to 
1,000  population. 

1894-95 15-9+ 

i895-'96 16.3+ 

i896-'97 15.6+ 

1897-98 14-7+ 

i898-'99 13.2+ 

i899-'oo 14-6+ 

i90o-'oi 18.2+ 

1901-02 15-6+ 

1902-03 13.4 

1903-04 13.7+ 

1904-05 13-8+ 

1905-06 15-0+ 


Total          Deaths  from 

Deaths  from 

Deaths.       Tuberculosis 

Phthisis. 

899 

103 

73 

944 

80 

55 

928 

107 

61 

888 

82 

6i 

826 

95 

83 

940 

108 

98 

1,163 

no 

92 

997 

104 

88 

884 

89 

68 

914 

74 

.67 

935 

102 

93 

1,035 

102 

84 

No.  of  death 

No.  of  deaths 

from  T.B.  to 

from  Phthisis  to 

1,000  population.            i 

,000  population 

1.8+ 

1.2+ 

1-3+ 

•9+ 

1.8+ 

1.0+ 

1-3+ 

1.0+ 

1-5+ 

1.3+ 

1-7+ 

1-5+ 

1-7+ 

1.4+ 

1.4+ 

1.2+ 

1-3+ 

1.0+ 

1.1+ 

1.0+ 

1-5+ 

1-3+ 

1.4+ 

1.2+ 

FOR   THE   INVESTIGATION   OF   TUBERCULOSIS. 


25 


MIDDLESEX   COUNTY. 


I 894-1 906. 


Estimated 
Population. 

1894-95 41,317 

1895-96 41,317 

i896-'97 44,191 

1897-98 44,285 

i898-'99 45,125 

i899-'oo 44,900 

iQCO-'oi 41,760 

1901-02 41,760 

1902-03 42,203 

1903-04 42,426 

1904-05 42,653 

1905-06 42,867 

No.  of  deaths  to 
1,000  population. 

1894-95 17-7+ 

1895-96 17-5+ 

i896-'97 174+ 

1897-98 14-8-1- 

i898-'99 16.3+ 

i899-'oo 16.3+ 

,i900-'oi 20.1-I- 

1901-02 18.0+ 

1902-03 i6.8-|- 

1903-04 19.4+ 

1904-05 18.5+ 

1905-06 18.8+ 


Total 
Deaths. 

Deaths  from    Deaths  from 
Tuberculosis.     Phthisis. 

733 

88 

70 

72s 

112 

80 

770 

89 

59 

659 

58 

42 

740 

82 

78 

735 

71 

69 

842 

76 

69 

752 

90 

86 

713 

82 

73 

826 

83 

73 

793 

84 

11 

807 

104 

91 

No.  of  deaths 

fromT.B.  to 

1,000  population. 

No.  of  deaths 
from  Phthisis  to 
1,000  population 

2.1+ 

1.6+ 

2.7+ 

1-9+ 

2.0-f- 

1.1+ 

1-34- 

.9+ 

1.8+ 

V 

1-7+ 

1-5+ 

1-5+ 

1.8+ 

1.6+ 

2.1+ 

2.0+ 

1.9+ 

1.7+ 

1-9+ 

1-7+ 

1-9+ 

1.8+ 

2.4+ 

2.1+ 

NEW  LONDON   COUNTY. 


1894-1906. 


Estimated 
Population. 

1894-95 79,995 

1895-96 79,995 

i896-'97 80,903 

1897-98 82,156 

i898-'99 83,911 

i899-'oo 86,951 

i900-'oi 82,758 

1901-02 82,758 

1902-03 83,984 

i903-'04 84,593 

1904-05 85,211 

1905-06 85,894 


Total 

Deaths  from 

Deaths  from 

Deaths. 

Tuberculosis. 

Phthisis. 

1,415 

190 

143 

1,386 

185 

149 

1,438 

188 

122 

1,372 

170 

125 

1,328 

141 

120 

1,270 

125 

112 

1,587 

154 

144 

1,433 

145 

126 

1,339 

144 

132 

1,492 

155 

138 

1,502 

138 

119 

1,476 

140 

116 

26 


REPORT   OF   THE    COMMISSION 


No.  of  deaths  to 
i,ooo  population. 

1894-95  ■•■ 17-6+ 

i89S-'96 17.3-f 

i896-'97 17.7+ 

1897-98 16.7 — 

i898-'99 15.7+ 

i899-'oo 14-6+ 

I900-'oi 17-9+ 

1901-02 17-3+ 

i902-'o.3 15.9+ 

i903-'o4 16.4+ 

1904-05 17-6+ 

1905-06 16.0-)- 


WINDHAM 
1894- 

Estimated 
Population. 

4-95 43,306 

1895-96 46,306 

i896-'97 45,690 

1897-98 47,536 

i898-'99 48,321 

i899-'oo 45,448 

igoo-'oi 46,861 

1901-02 46,861 

1902-03 47,192 

i903-'04 47,329 

1904-05 47,543 

1905-06 47,714 

No.  of  deaths  to 
1,000  population. 

1894-95 20.14- 

1895-96 19.7+ 

i896-'97 19-1+ 

1897-98 17.3+ 

i898-'99 16.7+ 

i899-'oo 17.5+ 

i90o-'oi 19.8+ 

1901-02 15-6+ 

i902-'03 15.5+ 

i903-'o4... 157+ 

1904-05 16.4+ 

1905-06 17.24- 


No.  of  deaths 

from  T.B.  to 

1,000  population 

. 

No.  of  deaths 
from  Phthisis  to 
1,000  population. 

2.34- 

1-74- 

2.3+ 

1.84- 

2.34- 

1-54- 

2.04- 

1-54- 

1.6+ 

1.44- 

1.44- 

1.24- 

1.8+ 

17+ 

1-7+ 

1-54- 

1-7+ 

1-54- 

1.84- 

1.6+ 

1.64- 

1-34- 

1.6+ 

1-34- 

COUNTY. 

Total           Deaths  from      Deaths  from 
Deaths.        Tuberculosis.       Phthisis. 

873 

107 

79 

914 

lOI 

69 

877 

96 

80 

824 

97 

73 

808 

94 

82 

796 

87 

76 

910 

108 

96 

732 

75 

70 

734 

72 

68 

746 

85 

57 

781 

78 

72 

822 

83 

7A 

No.  of  deaths 

from  T.B.  to 

1,000  population. 

No.  of  deaths 
from  Phthisis  to 
1,000  population. 

2.44- 

1-54- 

2.14- 

1.44- 

2.1-1- 

17+ 

2.0-}- 

1-54- 

1-9+ 

1.64- 

1.94- 

1.64- 

2.14- 

2.04- 

1.6+ 

1.44- 

I-S+ 

1.4-1- 

1-7+ 

1.24- 

1.64- 

1-5+ 

17-h 

1-5+ 

FOR   THE    INVESTIGATION   OF   TUBERCULOSIS. 


27 


TOLLAND   COUNTY 
1894-1906. 

Estimated 
Population. 

1894-95 25,892 

1895-96 25,892 

i896-'97 25,600 

1897-98 25,060 

i898-'99 24,675 

i899-'oo 26,066 

i900-'oi 24,523 

1901-02 24,523 

1902-03 24,417 

1903-04 24,356 

1904-05 24,303 

1905-06 24,248 

No.  of  deatlis  to 
1,000  population. 

1894-95 14-8+ 

1895-96 I7-I+ 

i896-'97 17.4+ 

1897-98 i6.o-|- 

i898-'99 16.3+ 

1899-00 14-5+ 

i900-'oi 18.54- 

1901-02 15.1-f- 

1902-03 14-9+ 

1903-04 17-6+ 

1904-05 15-8+ 

1905-06 15-2+ 


Total 

Deaths  fro 

m    Deaths  from 

Death? 

Tub 

erculosis.       Phthisis. 

38s 

40 

30 

449 

50 

33 

447 

46 

32 

402 

Z7 

35 

404 

33 

27 

378 

38 

36 

455 

41 

40 

372 

32 

27 

366 

31 

28 

441 

' 

52 

31 

385 

32 

27 

369 

30 

25 

No.  of  deaths 

No.  of  deaths 

fromT.B.  to 

from  Phthisis  to 

1,000  population. 

1,000  population. 

■5+ 

I.I+ 

•9+ 

1.2+ 

.8+ 

1.2+ 

.4+ 

1-3+ 

•3+ 

1.0+ 

•4 

1-3+ 

.6+ 

1.6+ 

■3+ 

1.1+ 

1.2+ 

1.1+ 

•1+ 

1.2+ 

•3+ 

1.1+ 

.2+ 

1.0+ 

It  appears  from  these  tables,  that  the  death  rate  in  our  cities 
has  been  very  nearly  the  same  as  that  of  the  whole  county.  This 
is  not  to  be  taken  as  any  evidence  against  the  excessive  develop- 
ment of  tuberculosis  in  large  cities.  It  is  clearly  due  to  the  fact 
that  there  are  no  large  cities  in  Connecticut,  and  that  the  condi- 
tions of  excessive  crowding  and  poverty  do  not  exist  to  a  great 
extent  in  any  section  of  the  State.  The  two  cities  in  the  State 
showing  an  increase  over  the  county  rate  are  New  Haven  and 
Bridgeport,  where  unsuitable  tenement  conditions  are  as  likely  to 
be  found  as  anywhere  in  the  State. 

Of  course  it  can  be  maintained,  in  relation  to  these  statistics, 
that  they  are  not  accurate;  that  many  cases  of  consumption  are 
returned    as    deaths    from    bronchitis    or    pneumonia,    or    other 


28  REPORT   OF   THE    COMMISSION 

diseases  that  neither  suggest  a  family  taint  nor  interfere  with  the 
full  payment  of  life  insurance.  But  there  is  no  reason  to  assume 
that  such  false  returns  are  more  frequent  in  one  county  than  in 
another. 

Early  in  April,  a  circular  was  addressed  to  a  resident  physician, 
the  town  clerk  and  the  town  health  officer  of  each  town  in  the 
State,  in  which  they  were  requested,  to  the  best  of  their  ability,  to 
answer  the  four  following  questions  : 

1.  Have  the  cases  of  consumption  occurred  frequently  in 
certain  houses  ? 

2.  Have  these  houses  harbored  cases  of  consumption  only 
when  tenanted  by  certain  families? 

3.  Have  the  houses  in  which  cases  of  consumption  occurred 
been  especially  damp  or  dark,  or  near  to  unhygienic  barns  or 
coops  ? 

4.  Have  the  cases  of  consumption  been  limited  to  one  particu- 
lar part  of  the  town,  or  have  they  occurred  in  all  parts  of  the, 
town  ? 

The  replies  have  been  surprisingly  numerous.  We  have  heard 
from  all  but  11  of  the  163  towns  to  which  the  circular  was  sent. 
Most  of  the  men  who  were  courteous  enough  to  answer,  were 
satisfied  with  saying  "Yes"  or  "No"  to  the  different  queries. 
A  few  of  the  town  clerks,  instead  of  answering  the  questions, 
simply  said  that  there  was  little  of  the  disease  in  their  towns.  As 
a  rule,  the  most  valuable  replies  were  from  the  physicians,  but 
some  of  the  lay  officials  showed  a  remarkably  intelligent  and 
sympathetic  interest  in  the  investigation. 

To  the  first  question,  "Have  the  cases  of  consumption  occurred 
frequently  in  certain  houses?"  the  great  majority  of  the  answers, 
as  will  be  seen  by  the  table,  were  in  the  negative.  Yet  in  the  33 
affirmative  replies,  some  interesting  facts  were  developed.  Of 
these,  only  16  reported  that  the  houses  in  which  frequent  cases 
of  consumption  occurred,  harbored  cases  after  a  first  consump- 
tive family  moved  out. 

Only  about  one-fourth  of  the  reporters  say  that  insanitary 
environment  was  usual  in  the  houses  in  which  consumption 
occurred,  and  of  this  one-fourth,  a  majority  lay  emphasis  on  a 
damp  cellar  as  a  common  finding  in  the  house  of  the  consumptive. 

With  practical  unanimity,  the  reporters  state  that  the  cases  of 
consumption  have  occurred  in  all  parts  of  the  towns. 


FOR   THE   INVESTIGATION    OF   TUBERCULOSIS.  29 

The  260  answers  received  from  the  152  towns  may  be  tabulated 
as  follows : 

Q.  I.  Have  the  cases  of  consumption  occurred  frequently  in 
certain  houses? 

A.     No,  181 ;  Yes,  33  ;   No  answer,  44. 

Q.  2.  Have  these  houses  harbored  cases  of  consumption  only 
when  tenanted  by  certain  families^? 

A.     No,  8;  Yes,  16;  Doubtful,  i. 

Q.  3.  Have  the  houses  in  which  cases  of  consumption  occurred 
been  especially  damp  or  dark,  or  near  to  unhygienic  barns  or 
coops  ? 

A.     No,  173  ;  Yes,  32  ;  No  answer,  48. 

Q  4.  Have  the  cases  of  consumption  been  limited  to  one  part 
of  the  town,  or  have  they  occurred  in  all  parts  of  the  town? 

A.  All  parts,  202;  One  particular  part,  2;  No  answer,  51; 
Two  parts,  i. 

The  Commission  feels  that  a  few  of  these  letters  will  be  of 
interest.  With  due  appreciation  of  the  courtesy  of  the  writers, 
it  seems  best  to  publish  them  impersonally. 

No.  I.  "To  illustrate  from  my  practice,  a  farmer  and  wife, 

apparently  healthy,  came  from  with  a  family  of  four 

children,  and  bought  a  farm.  As  children  came  to  adolescence, 
they  died  of  consumption  until  all  but  one  were  gone,  and  she  has 
spent  years  in  a  sanatorium.  They  sold  the  place,  but  not  before 
they  had  adopted  two  children,  and  moved  to  another.  One  of 
the  adopted  children  is  phthisical  and  father  has  active  focus  on 
lung.  No  family  history.  No  signs  before  coming  to  that  house. 
I  can  get  no  history  of  there  having  been  any  in  the  house,  yet 
where  did  it  come  from?  They  are  good,  nice,  clean,  religious 
people." 

No.  2  r-eports  all  the  cases  occurring  in  the  town  since  January 
I,  1904,  43  in  number,  and  concerning  them  he  makes  the  follow- 
ing comments :  "Nearly  all  the  cases  are  widely  separated  from 
each  other,  and  no  two  in  the  same  house,  except  in  two  instances. 
I  am  well  acquainted  with  the  location  of  the  houses,  and  except 

one  on Avenue  and  one  on Street,  they  are  all 

high  and  dry." 

No.  3  says,  in  answer  to  question  four:  "No  particular  part  of 
town ;  though  I  am  of  the  opinion  that  the  larger  number  of  our 
cases  are  in  the  near  vicinity  of  the  Connecticut  River." 


30  REPORT   OF   THE    COMMISSION 

No.  4  says  :  "Cases  have  not  been  limited  to  one  particular  part 
of  the  town.  They  have  been  general,  and  as  frequent  in  the 
farming  sections  (if  not  more)  than  in  the  manufacturing 
sections." 

No  5.  The  Commission  appreciates  highly  the  response  to 
their  questions  contained  in  the  following  interesting  letter:  "I 
am  deeply  interested  in  the  work  of  your  Commission,  and  am 
glad  to  be  of  any  assistance.  I  have  examined  the  records  of 
deaths  in  this  town  since  October,  1896,  at  which  time  I  assumed 
the  duties  of  Registrar,  and  have  taken  the  names  of  all  persons 
who  have  died  from  tuberculosis  during  the  eleven  and  one-half 
years  which  have  elapsed  since  that  date.  Fourteen  deaths  have 
occurred  during  the  period,  but  I  shall  exclude  one  in  answering 
inquiries,  because  of  the  fact  that  in  that  case  the  person  came 
into  town  in  the  last  stages  of  the  disease,  living  but  a  few  weeks. 

"I  am  surprised  to  find,  on  looking  over  this  list,  that  every 
death  occurred  within  a  mile  of  the  Connecticut  River,  or  its 
tributary,  Eight-Mile  River.  This  may  be  a  mere  chance,  and  I 
had  never  thought  of  the  disease  being  at  all  confined  to  certain 
localities,  but  you  will  further  see  that  nine,  or  nearly  three- 
quarters  of  the  deaths,  were  in  one  very  small  corner,  as  shown  by 
the  enclosed  map, 

"In  the  house  marked  '4',  the  first  death  occurred  in  June,  1897, 
the  victim  being  a  lady  of  thirty-six,  who  had  up  to  a  few  months 
before  been  very  strong  and  healthy.  In  December,  1892,  a 
brother  died,  aged  twenty-nine,  and  in  May,  1903,  another  sister 
was  taken,  at  the  age  of  thirty,  after  a  long  illness,  which  she 
endeavored  to  overcome  by  outdoor  life  here  and  in  the  West.  In 
January,  1906,  the  father  died,  at  the  age  of  eighty.  The  house 
occupied  by  this  family  has  been  the  home  of  their  ancestors  since 
before  the  Revolution,  and  I  am  informed  that  no  other  cases  have 
ever  been  known  there.  Although  near  the  water,  the  house 
stands  in  a  sunny,  well-drained  location. 

"The  house  marked  '2'  is  not  as  well  situated,  but  is  near  a 
large  marsh  and  built  into  a  bank  on  the  rear.  The  first  case  was 
that  of  a  girl  of  sixteen ;  the  second  that  of  her  mother,  two  years 
later,  the  mother  having  taken  all  the  care  of  her  daughter,  and 
beginning  to  fail  in  health  soon  after  her  death.  With  the  excep- 
tion of  two,  all  of  the  persons  dying  from  tuberculosis  since  1896 


FOR   THE   INVESTIGATION    OF   TUBERCULOSIS.  3 1 

have  been  native  Americans,  and  all  but  one  have  lived  in  this 
locality  most  of  their  lives. 

"All  of  the  homes  are  on  a  par  with  the  average  country  home, 
and  with  two  or  three  exceptions,  the  locations  would  appear  to 
be  healthful.  More  than  half  of  the  victims  were  past  middle 
life,  and  only  two  were  under  twenty-five. 

"In  the  past,  tuberculosis  has  been  by  no  means  confined  to  one 
section  of  the  town,  and  a  general  examination  of  the  records 
for  fifty  years  back  seems  to  show  that  the  average  death  rate 
from  this  cause  forty  to  fifty  years  ago  was  thirty  to  fifty  per 
cent,  greater  than  at  present. 

"I  hope  I  have  not  gone  into  details  too  much,  but  knowing  the 
people  of  my  town  and  their  condition  personally,  I  thought  these 
facts  might  be  of  interest. 

"There  have  been  no  deaths  in  this  town  from  tuberculosis  for 
more  than  two  years,  and  so  far  as  I  know,  there  are  no  clearly 
defined  cases  here  at  present." 

No.  6.  Dr.  George  H.  Wright  of  New  Mil  ford  says,  that  most 
of  the  cases  in  the  neighborhood  of  New  Milford  occur  among 
men  grinding  silica,  and  he  suggests  that  the  State  find  a  way  to 
do  away  with  the  dangers  of  the  present  methods  of  grinding, 
either  wet  or  dry. 

No.  7  says :  "We  have  in  our  town  two  houses,  in  which  the 
people  who  have  occupied  them  for  the  last  fifty  years  have  died 
with  tuberculosis. 

"Taking  up  the  matter  of  the  first  house,  I  would  say  that  the 
old  residents  were  of  New  England  stock,  and  with  one  exception, 
died  with  said  disease.  About  fifteen  or  twenty  years  ago,  a 
family  from  Sweden,  who  were  apparently  well  and  strong  when 
they  arrived,  lost  four  of  the  family,  who  died  with  the  same 
disease  in  this  house. 

"The  house  is  free  from  tenants  at  the  present  time ;  in  fact, 
has  not  been  occupied  for  three  or  four  years.  The  other  house, 
history  shows  the  death  of  the  old  New  England  farmer,  his  first 
wife,  second  wife  and  himself,  who  died  of  consumption. 
Another  family  moved  in ;  the  father  old  New  England  stock,  the 
mother  Irish.  They  raised  seven  children,  five  of  whom  died  with 
tuberculosis.  One  daughter,  despondent  because  of  her  condi- 
tion of  health,  and  having  been  told  by  physicians  that  she  would 
3 


32  REPORT   OF   THE    COMMISSION 

die  of  consumption,  drowned  herself.  The  other,  a  son,  was 
drowned.  Then  a  family  from  Canada,  French  people,  moved 
into  the  house,  and  the  mother  has  just  died  with  consumption. 
In  fairness  to  the  history,  I  will  say,  when  the  woman  came  from 
Canada,  the  physician  told  her  she  had  bronchial  trouble,  but 
never  told  her  she  had  tuberculosis.  However,  after  living  there 
a  short  time,  she  was  taken  with  the  same  disease  and  died. 
•  "Neither  of  the  houses  are  damp  or  dark,  nor  have  barns  or 
coops  near  enough  to  be  unsanitary.  The  cases  of  consumption 
have  not  been  limited  to  any  part  of  the  town,  but  occasionally  in 
various  sections  of  the  town.'' 

No.  8  says :  "In  one  house  built  by  the  father  forty  years  ago, 
and  no  other  family  occupying  it,  when  the  youngest  of  the 
children  was '  about  twelve  years  old,  she  died  with  consumption ; 
in  about  two  years  the  next  oldest  died,  and  in  about  two  years  the 
next  died — all  girls,  and  apparently  healthy  until  the  first 
developed  the  disease.  There  are  two  older  sisters  still  living  and 
in  fairly  good  health.  The  house  is  in  good  situation  and  well 
cared  for. 

"In  house  No.  3,  built  about  twenty  years  ago,  there  was  a  case 
of  tuberculosis  in  the  first  family  residing  in  it.  This  family 
moved  away  and  another  family  came,  and  in  a  few  years  three  of 
the  second  family  died.  When  this  family  moved  to  another 
house,  another  member  of  the  family  died  in  a  few  months,  and 
then  another  was  taken  ill  with  the  disease,  but  was  sent  to  the 
Wallingford  Home  and  returned  very  much  improved,  and  still 
seems  to  be  improving.  This  house  is  on  low,  wet  ground,  with 
damp  cellar." 

No.  9  writes :  "I  find  upon  examination  of  the  records  of  this 
town,  that  in  the  last  fifty  years,  which  is  as  far  back  as  the  records 
are  accurate  in  the  matter  of  deaths,  that  there  were  176  deaths 
from  tuberculosis,  an  average  of  about  3^  each  year.  Dividing 
this  into  two  periods  of  25  years  each,  it  shows  that  during  the 
first  period  there  were  116  deaths,  a  little  over  4^  per  year.  In 
the  second  period,  from  1882  to  date,  there  were  60  deaths,  an 
average  of  2^  per  year. 

"Again,  taking  up  the  period  from  1888  to  1898,  33  deaths,  and 
from  1898  to  1908,  17  deaths,  which  shows  a  remarkable  decrease. 
I  cannot  find  any  locality  where  the  disease  has  appeared  for  any 
length  of  time.     The  cases  are  scattered  over  all  sections  of  the 


FOR    THE    INVESTIGATION    OF   TUBERCULOSIS.  33 

town,  and  in  the  majority  of  cases,  isolated.  I  find  that  in  some 
families  there  have  been  several  deaths  in  one  house,  no  cases 
having  appeared  in  that  locality  or  house,  either  before  or  after  the 
removal  of  that  family  from  that  particular  house  or  locality." 

No.  ID  says  concerning  that  town :  "For  a  manufacturing  town, 
with  its  mixed  population,  exceedingly  unhygienic  tenements,  and 
no  general  sewer  system,  we  have-  very  little  consumption.  Our 
freedom  from  it  has  been  ascribed  to  the  fact  that  so  many  are 
employed  in  the  paper  mills,  which  use  large  quantities  of  chloride 
of  lime ;  also  that  the  chloride  not  only  disinfects  those  who  work 
in  the  mills,  but  tends  to  disinfect  the  air.  of  the  town.  This 
would  hardly  seem  to  explain  the  comparative  immunity  from 
tuberculosis,  for  we  certainly  have  enough  other  infectious  and 
contagious  diseases,  except  typhoid. 

"In  Litchfield  County,  where  I  practiced  six  years,  we  had  a 
good  many  cases  of  consumption,  and  there  were  many  houses, 
old,  damp  and  poorly  lighted,  where  several  successive  families 
had  developed  tuberculosis,  often  two,  three  and  even  five  mem- 
bers of  the  same  family  dying  one  after  the  other. 

"I  cannot  say  that  unhygienic  barns  or  coops  were  a  factor, 
but  dampness,  filth,  and  failure  to  paint  and  whitewash,  after  the 
house  had  been  infected,  were  nearly  always  factors." 

No.  II  says,  that  the  cases  have  occurred  'Tn  the  valley,  and  on 
the  mountain  top ;  in  all  parts  of  the  town." 

No.  12  reports:  "Many  of  the  houses  are  very  old,  many  over 
the  century  mark,  and  more  from  fifty  to  ninety  years  of  age.  In 
many,  no  doubt  there  have  been  more  than  one  case  of  tubercu- 
losis, but  I  do  not  recall  any  marked  ones. 

"Regarding  this  place,  we  have  had  considerable  tuberculosis 
during  the  thirty-five  years  of  my  practice,  but  I  believe  not  as 
much  as  in  many  towns  of  like  size.  It  has  been  amongst  all 
classes,  rich  and  poor,  native  and  foreign  born,  and  I  must  con- 
fess, with  a  good  many  cases  in  the  same  family. 

"In  many  years  past  it  is  of  record  that  whole  families  like  the 
Y's,  a  family  of  six,  and  the  H's,  a  family  of  seven,  were  taken 
one  by  one,  until  all  are  gone,  or  maybe  one  left  to  grow  old." 

No.  13  gives  the  following  succinct  data:  "In  one  house,  same 
family,  six  deaths ;  one  house,  same  family,  four  deaths ;  three 
houses,  same  family,  three  deaths ;    one.  family,  three  deaths  in 


34  REPORT   OF   THE    COMMISSION 

two  houses ;  one  family,  four  deaths  in  three  houses ;  nine 
families,  two  deaths  each  in  nine  houses." 

He  says  that  125  cases  have  been  reported  since  they  organized 
as  a  town  in  1869 — ^44  cases  in  16  families,  and  81  cases  in  as  many 
families,  scattered. 

No.  14.  The  following  history  is  one  of  unusual  interest: 
"James  and  Margaret,  each  now  ninety  years  old,  were  the 
parents  of  seven  children,  five  girls  and  two  boys.  The  last  child 
died  four  years  ago  last  fall.  All  were  born  and  raised  on  the 
farm,  and  all  were  well  developed  and  well  nourished.  All  but 
two  of  them  died  on  the  farm.  The  farmhouse  was  low-studded, 
a  short  roof  on  one  side  and  a  long  roof  on  the  other  side  reaching 
to  the  ground.  The  barn  was  fifty  feet  away.  In  it  were 
usually  kept  twelve  to  fifteen  cows  and  horses — no  goats  or  sheep. 
This  barn  was  unhealthy  and  located  between  three  swamps, 
which  were  an  eighth,  a  tenth  and  a  sixth  of  a  mile  distant. 
Most  of  the  children  assisted  in  the  milking  of  the  cows.  The 
milk  was  used  on  the  place  and  made  into  butter  and  cheese.  The 
girls  usually  left  home  when  about  sixteen  years  of  age,  to  work 
in  hotels  and  families  as  servants,  and  usually  returned  home 
sick,  where  they  lasted  from  six  months  to  four  years." 

In  many  of  the  houses,  alluded  to  in  these  letters  from  some  of 
our  most  beautiful  country  towns,  there  may  possibly  have  been 
nothing  to  indicate  the  reason  for  the  persistence  of  the  tubercu- 
lous infection.  In  most  of  them  the  owners  were  undoubtedly 
industrious  and  worthy  people.  In  practically  all  of  them,  it  is 
quite  possible  that  the  blinds  were  tightly  closed,  the  windows 
always  closed,  except  during  house-cleaning,  the  cellar  window- 
less,  or  nearly  so ;  in  short,  they  were  all  barred  against  sunlight 
and  fresh  air,  as  has  been  the  almost  universal  custom  in  Con- 
necticut for  generations.  The  sun  may  fade  the  carpet,  but  if  it 
puts  healthful  color  into  the  cheeks,  the  exchange  is  no  loss. 

Upon  a  farm  located  in  the  most  healthful  part  of  Connecticut,  a 
family  has  resided  for  some  years  that  was  of  the  kind  so  often 
described  as  "consumptive."  Four  members  of  the  family  had 
died  of  tuberculosis  and  two  were  seriously  infected,  when  one 
member  of  the  family,  in  seeking  employment,  was  hired  by  a  sani- 
tarium for  the  treatment  of  tuberculosis.  While  in  service  at  the 
sanitarium,  the  girl  learned  the  value  of  fresh  air  and  sunlight  and 
returned  home  to  institute  reform.     The  house  was  completely 


FOR    THE    INVESTIGATION    OF    TUBERCULOSIS.  35 

embedded  in  trees ;  the  windows  were  never  opened  and  no 
attempt  had  ever  been  made  to  disinfect.  All  was  immediately 
changed ;  the  trees  came  down,  the  fresh  air  was  admitted  every- 
where, paint  and  work  cleaned  the  place.  The  two  invalids 
remained  at  home  and  began  to  improve.  One  is  well  to-day,  the 
other  improving.  Not  another  case  has  developed  in  that  house. 
The  farm  was  attractive,  the  people  industrious.  The  story 
applies  to  hundreds  of  homes  in  New  England  to-day.  The 
disease  and  death  are  not  in  such  cases  to  be  attributed  to  a  want 
of  cleanliness,  but  to  a  lack  of  understanding  as  to  the  vital 
importance  of  sunlight  and  fresh  air. 

From  the  facts  at  hand  it  would  appear  that 

Human  tuberculosis  has  occurred  in  all  parts  of  Connecticut — 
highland  and  lov/land  and  plain,  in  city  or  village. 

There  is  considerable  evidence  to  show,  that  in  rural  Connecti- 
cut human  tuberculosis  occurs  most  frequently  in  badly  drained 
districts  and  in  houses  with  damp  cellars. 

The  reports  received  do  not  support  the  view,  that  in  rural  Con- 
necticut cases  of  consumption  occur  frequently  in  close  proximity 
to  unsanitary  barns  or  coops. 

While  the  preponderance  of  testimony  is  that  in  rural  Con- 
necticut only  a  minority  of  cases  of  consumption  have  been  fol- 
lowed by  other  cases  in  the  same  house,  or  the  same  family,  the 
evidence  in  favor  of  the  hypothesis  of  "consumption  houses" 
and  "consumption  families"  is  often  very  striking  and  is  deserv- 
ing of  careful  consideration. 

The  fact  that  private  houses  may  become  infected  with  tuber- 
culosis, as  well  as  the  larger  tenements,  is  conceded.  Where 
such  residences  are  occupied  by  one  family,  it  does  not  appear  that 
the  State  has  any  duty  in  the  matter.  With  people  of  even 
ordinary  intelligence,  to  know  the  facts  should  be  enough  to  secure 
correction  of  the  evil,  and  the  local  health  officer  already  possesses 
the  power  to  disinfect  such  premises.  A  physician  in  attendance 
upon  such  a  family  holds  a  position  of  responsibility,  and  is  dere- 
lict in  his  duty  if  he  does  not  recognize  the  necessity  for  disinfec- 
tion and  proper  living,  and  make  such  necessity  apparent  to  his 
patients.  In  tenements  where  several  families  are  under  the  same 
roof,  it  is  the  duty  of  the  State  to  see  that  these  families  are  pro- 
tected. One  careless  and  indifferent  consumptive  may  imperil  the 
whole  tenement,  and  without  the  aid  of  the  State  the  occupants 


36  REPORT    OF    THE    COMMISSION 

of  the  house  have  no  redress.  So  long  as  the  laboring  people 
are  forced  to  reside  in  tenement  houses,  simply  by  reason  of  the 
lack  of  more  desirable  accommodations,  it  is  the  duty  of  the  State 
to  protect  them  against  abuses  in  the  construction  and  main- 
tenance of  the  building.  So  far  as  the  construction  of  tenement 
houses  is  concerned,  the  law  of  Connecticut,  as  it  has  been  in  force 
since  June  29,  1905,  would  seem  to  be  satisfactory  and  to  ensure  in 
all  tenements  to  be  erected  in  the  future  a  sufficient  provision  of 
light  and  air.  To  secure  this  result,  it  is  indispensable  that  the 
law  should  be  enforced.  As  to  tenements  already  in  existence, 
the  State  law  has  no  effect.  It  controls  the  construction  in  the 
future.  It  does  not  affect  the  old  tenement  and  lodging-houses 
that  have  been  occupied  for  many  years  and  are  in  some  instances 
inconceivably  filthy.  The  control  of  this  evil  must  reside  in  the 
health  officer  of  the  community  in  which  it  exists.  How  far  the 
control  of  the  State  Board  of  Health  might  be  substituted,  in  the 
matter  of  tenement  inspection,  is  a  question  worthy  of  considera- 
tion. It  is  not  always  easy  for  a  local  health  officer  to  combat 
strong  political  pressure.  It  is  his  duty  to  do  so,  of  course ;  but 
if  the  performance  of  his  duty  results  in  the  appointment  of  a 
substitute  more  congenial  to  the  tenement  owners,  then,  certainly, 
no  good  has  been  gained.  Inspection  placed  in  the  hands  of  an 
outside  inspector,  beyond  local  control,  might  be  more  effective. 
This  question  is  beyond  the  scope  of  this  report.  It  is  fair  to 
say  in  addition,  that  if  the  public  is  interested  in  an  effective 
administration  of  the  local  health  boards,  and  is  ready  to  uphold 
them  in  their  efforts  to  control  these  tenement  abuses,  then  they 
must  see  to  it  that  the  health  officers  receive  a  salary  to  some 
degree  commensurate  with  their  responsibility.  Your  Commis- 
sion desires  to  be  on  record  as  advocating  state  tenement  house 
inspectors,  to  act  in  cooperation  with  the  local  health  authorities 
and  to  assume  responsibility,  if  need  be,  for  such  action  as  may  be 
required  to  protect  the  public  health. 


FOR    THE    INVESTIGATION    OF    TUBERCULOSIS.  37 


FACTORY  CONDITIONS. 


It  is 'manifestly  wrong,  that  one  who  is  cleanly  in  person,  who 
takes  all  possible  precautions  against  infection  in  the  home,  should 
be  subjected  to  possible  infection  from  preventable  sources  in  the 
place  where  he  or  she  has  to  work  for  a  living. 

It  is  the  duty  of  the  public  to  see  that  the  conditions  in  all  work- 
shops are  made  as  safe  as  is  practicable,  and  that  whatever  safe- 
guards may  be  necessary  to  that  end  are  provided. 

What,  then,  are  the  sources  of  danger  to  be  provided  against 
in  the  workshop? 

Spitting.  This  pernicious  habit  has  already  been  referred  to  as 
being  especially  prolific  of  harm  to  the  whole  community.  In 
workshops  and  stores  it  attains  its  highest  efficiency  as  a  destroyer 
of  public  health.  If  persons  infected  with  tuberculosis  expec- 
torate on  the  floors  or  walls,  the  sputum  becomes  dried  and  is 
inhaled  by  their  fellow-workers  to  their  great  danger.  This  is  the 
most  easily  prevented  source  of  infection,  and  it  should  be  made 
a  misdemeanor  for  any  person  to  expectorate  upon  the  floors, 
walls  or  stairways  of  any  factory,  store,  public  building  or  vehicle, 
and  the  owners  should  be  required  to  post  the  law  in  conspicuous 
places.  The  factory  inspector  should  have  the  authority  to 
require  suitable  spittoons,  in  such  numbers  and  places  as  may  be 
necessary ;  and  to  require  that  they  be  cleaned  and  disinfected  at 
regular  intervals,  not  less  than  twice  a  week,  or  oftener  if  neces- 
sary ;  and  he  should  further  require  that  they  be  kept  partly  filled 
with  water,  or  disinfectant. 

The  Massachusetts  Commission  has  recommended  that  spitting 
upon  the  floors  or  walls  of  factories  be  prohibited  by  law,  but 
their  recommendation  is  not  sufficient,  as  it  provides  no  penalty. 
At  the  present  time,  with  very  few  exceptions,  there  is  practically 
nothing  done  in  Connecticut  to  prevent  indiscriminate  spitting, 
or  to  provide  spittoons  in  even  the  best  managed  factories. 
Recently,  the  subject  has  been  so  forcibly  brought  to  the  atten- 
tion of  the  public,  as  a  measure  for  the  suppression  of  tuberculosis, 


38  REPORT   OF   THE    COMMISSION 

that  a  f evvT  factories  are  endeavoring  to  check  the  evil.  But  condi- 
tions in  most  factories  in  this  respect  are  as  bad  as  they  can  pos- 
sibly be,  all  corners  and  walls  being  foul  with  spittle  and  tobacco 
juice.  The  efforts  made  to  educate  the  public  as  to  this  foul 
and  unnecessary  habit  will  in  time  create  a  sentiment  among  the 
workmen  themselves,  that  will  be  the  most  potent  influence  toward 
its  correction.  Until  that  time  arrives,  the  factory  inspector 
should  be  endowed  with  every  power  requisite  to  enforce  reform. 
Many  manufacturers  have  expressed  to  the  Commission  a  desire 
to  be  informed  as  to  a  simple  and  practicable  method  for  con- 
trolling expectoration  in  the  shops.  The  problem  is  no  mean 
one — how  to  cleanse  3,000  cuspidors  a  day  calls  for  careful  con- 
sideration. The  plan  adopted  by  the  United  States  Government 
Printing  Office,  which  was  exhibited  at  the  exhibition  in  Wash- 
ington, during  the  International  Congress  on  Tuberculosis,  was  so 
simple  and  effective  that  a  large  part  of  the  pamphlet  explaining 
the  work  is  inserted  in  this  report,  with  an  earnest  recommenda- 
tion that  all  manufacturers  will  give  the  matter  due  consideration. 

"In  the  United  States  Government  Printing  Office,  approxi- 
mately 4,800  persons  are  employed  under  one  roof.  A  great 
many  there  employed  have  sedentary  duties,  their  work  being 
placed  directly  in  front  of  them  or  within  a  given  space.  Many 
use  tobacco,  which  excites  salivation  and  consequent  expectora- 
tion, and  as  a  result  of  this  condition,  about  1,400  cuspidors  are 
required  for  use,  and  which  must  be  cleaned  at  the  termination 
of  each  eight-hour  shift. 

"Some  idea  of  the  magnitude  of  this  work  may  be  gained,  when 
one  considers  that  under  the  old  system  about  400  barrels  of 
sawdust  were  used  each  month,  at  a  cost  of  $100,  to  fill  spit 
boxes.  The  sputum  caked  and  accumulated  against  the  sides  of 
boxes  which  could  not  be  thus  properly  cleaned,  and  as  a  result 
they  were  insanitary  and  dangerous  to  health. 

"Under  the  present  method,  now  being  installed,  the  cleaner 
picks  up  the  dirty  or  used  cuspidors,  five  at  one  time,  in  a  'nested' 
fashion,  by  a  specially  designed  clutch  or  device,  as  shown  in 
exhibit,  and  with  the  movement  of  one  arm  only.  The  five 
vessels,  so  confined,  are  then  carried  to  a  box  truck  lined  with 
galvanized  iron.  After  the  truck  has  been  filled  (they  hold  140 
cuspidors),  in  this  manner,  it  is  pushed  to  the  freight  elevator  on 


FOR    THE    INVESTIGATION    OF    TUBERCULOSIS.  39 

each  of  the  respective  floors,  and  by  this  means  is  taken  to  the 
basement,  whence  the  truck  is  wheeled  directly  into  the  sterilizing 
chamber. 

"Here  the  cuspidors  are  cleaned  and  sterilized  with  boiling 
water  and  steam,  the  contents  of  vessels  being  carried  or  flushed 
directly  into  the  sewer  by  means  of  a  drainpipe. 

"After  remaining  in  the  racks  long  enough  to  dry,  where  they 
are  placed  directly  after  the  steam  and  water  bath,  the  operator 
pulls  the  vessels  from  the  rack  and  places  them  back  into  the 
truck.  As  each  layer  of  cuspidors  is  placed  in  the  truck,  about 
two  or  three  ounces  of  a  disinfecting  solution  is  poured  into  each. 

"The  solution  is  used  to  disinfect  the  sputum  and  to  destroy  or 
greatly  attenuate  (weaken)  all  forms  of  germ  life,  including  the 
tubercle  bacillus  (consumption  germ),  and  the  organism  causing 
pneumonia  in  its  various  forms,  that  may  be  found  in  the 
expectorations.  The  antiseptic  remains  in  the  cuspidor  until  it 
is  washed  again. 

"The  solution  is  composed  of  bichloride  of  mercury,  citratic 
acid  and  a  coloring  agent,  and  is  odorless.  The  bichloride  of 
mercury  is  used  for  its  germicidal  and  antiseptic  properties,  tests 
having  shown  that  the  most  resistant  disease  germs  die,  when 
brought  in  contact  with  this  agent,  in  less  than  half  a  minute.  The 
citric  acid  used  retards  the  coagulation  or  lumping  of  albumin  in 
saliva,  thus  rendering  the  mercury  more  potent  and  penetrating  to 
the  mass.  The  coloring  agent  (eosin)  is  used  to  differentiate  the 
solution  from  harmless  hquids,  such  as  water,  only  as  a  matter 
of  precaution. 

"The  operator  at  no  stage  of  the  collection  or  cleaning  pro- 
cedure touches  his  hands  or  person  to  the  dirty  vessels,  thus 
avoiding  danger  of  infection  to  himself  and. others.  The  cus- 
pidors used  in  demonstration  were  especially  designed  for  service 
in  the  Government  Printing  Office,  and  are  made  without  any 
sharp  angles  or  overhangs,  thus  presenting  a  vessel  that  is  self- 
draining  and  permits  of  very  easy  cleaning. 

"Experience  has  shown  that  it  is  almost  impossible  to  have  the 
ordinary  stock  cuspidors  properly  cleaned,  owing  to  the  sharp 
undercuts  and  overhangs  and  the  repugnance  of  the  work  in 
general.  The  cuspidors  now  in  use  are  made  of  hard,  tough, 
vitreous  ware,  to  stand  rough  usage,  and  at  the  same  time  to 
withstand  the  corrosive  action  of  bichloride  of  mercury,  in  addi- 


40  REPORT   OF   THE    COMMISSION 

tion  to  presenting  a  smooth  sanitary  surface  for  cleaning  pur- 
poses.    The  cost  is  about  thirty-eight  cents  apiece  wholesale. 

"The  chemicals  going  to  make  up  the  solution  necessary  for 
an  entire  year's  supply  in  the  Government  Printing  Office  cost 
about  fourteen  dollars — five  gallons  can  be  made  for  less  than 
two  cents — and  may  be  purchased  at  any  drug  store  or  chemical 
concern.  The  labor  of  one  man  at  two  dollars  per  diem  covers 
the  cost  of  operation  for  each  twenty-four  hours,  or  three  eight- 
hour  shifts. 

"No  device  or  method  in  connection  with  this  exhibit  is 
patented,  and  all  or  any  part,  if  desired,  may  be  freely  copied 
by  manufacturers  and  persons  interested  in  stamping  out 
tuberculosis." 

Sweeping.  The  factory  inspector  should  have  full  power  to 
regulate  the  method  of  sweeping  in  shops  and  stores.  No  method 
should  be  allowed  that  results  in  the  raising  of  clouds  of  dust 
that  must  carry  with  it  and  scatter  broadcast  the  material  for 
infection.  This  regulation  is  to  the  owner's  interest  as  well  as 
the  employee's.  The  method  of  sweeping,  whether  by  damping 
or  by  use  of  some  mechanical  contrivance  for  that  purpose, 
should  be  left  to  the  judgment  of  the  owner.  Proper  efforts  to 
avoid  dust  during  the  process  of  cleaning  the  shops  are  now 
in  force  in  the  best  shops  in  the  State.  Where  attention  to  the 
matter  is  neglected,  it  should  be  immediately  corrected. 

Dangerous  Occupations.  There  are  certain  occupations  where 
tuberculosis  is  much  more  common  than  in  others,  such  as  buff- 
ing, polishing,  grinding,  working  with  emery  or  carborundum  in 
foundries,  or  in  other  work  on  metals  where  minute  particles  of 
metal  are  taken  into  the  lungs,  causing  irritation  of  the  passages 
and  creating  an  inflammatory  condition  favorable  to  the  lodgment 
and  subsequent  development  of  the  germs.  Cutlery  grinders 
and  stone  cutters  are  particularly  prone  to  contract  the  disease. 

All  persons  working  in  dusty  occupations  of  any  kind  are  liable 
to  contract  tuberculosis.  Among  the  occupations  most  favorable 
to  the  development  of  the  disease  may  be  classed  work  in  rooms 
where  hemp,  cotton,  woolen  or  silk  is  opened,  carded,  picked  or 
spun,  and  where  dust  and  fibre  are  floating  in  the  air ;  also  in  the 
fur-cutting  rooms  in  hat  manufacturies,  and  in  woodworking 
establishments,  such  as  bobbin  shops,  where  there  is  much  fine 
sawdust. 


FOR   THE    INVESTIGATION    OF    TUBERCULOSIS.  41 

Those  occupations  are  also  classed  as  dangerous  where  there 
are  irritating  fumes  of  chemicals  or  metals,  such  as  blast  furnaces, 
nickel  and  silver  plating,  japanning,  lacquering  and  hat  making, 
also  where  persons  are  subject  to  extreme  heat,  such  as  glass- 
works, etc.,  or  where  the  workers  sit  or  stand  in  cramped  positions, 
as  tobacco  workers,  garment  workers,  etc. 

Wet  Grinding  and  Polishing.  ^What  measures,  then,  can  be 
taken  to  make  occupations  of  the  above  classes  less  dangerous? 
It  is  probable  that  no  step  in  this  direction  has  been  of  more 
value  than  the  substitution  of  wet  for  dry  grinding  in  cutlery, 
the  latter,  we  believe,  being  nearly  eliminated.  The  same  principle 
could  be  followed,  wherever  practicable,  in  a  great  variety  of 
cutting  and  polishing  operations  in  the  metal  trades,  by  the  use 
of  water  or  oil,  either  on  the  polishing  or  grinding  surface,  or  in 
jets  of  spray  which  would  carry  down  the  dust. 

Exhmist  Fans.  Second,  the  introduction  of  exhaust  fans  and 
dust  separators  v\^ith  hoods  over  dusty  machines,  carrying  away 
the  dust  from  the  operator,  is  to  be  recommended.  The  same 
method  should  be  adopted  in  all  places  where  there  are  poisonous 
or  irritating  fumes. 

Dressing  Rooms.  Third,  providing  washrooms  and  dressing- 
rooms,  and  places  to  dry  the  clothing  taken  off,  in  such  trades  as 
require  work  in  wet  clothing,  that  the  workers  may  not  catch 
cold  from  going  out  in  wet  clothing. 

Conditions  in  Connecticut.  The  state  factory  inspector  reports, 
that  such  conditions  for  the  workers  in  this  State  are  much  above 
the  average,  and,  on  the  whole,  fairly  good ;  that  the  laws  govern- 
ing such  cases  are  satisfactory  and  that  the  manufacturers  show 
a  disposition  to  do  what  is  right ;  and  that  he  is  issuing  orders  as 
fast  as  practicable,  requiring  the  introduction  of  exhaust  fans,  dust 
separators,  and  also  washing-  and  dressing-rooms  in  foundries. 
He  says  that  all  such  orders  are  complied  with  in  a  reason- 
able time.  His  report  for  1906,  the  last  published,  shows  forty- 
five  new  washrooms,  etc.,  ordered  in  foundries  and  other  places, 
and  eighteen  orders  relating  to  exhaust  systems  and  hoods.  Of 
course,  this  only  represents  one  5^ear's  work. 

n  those  who  are  deeply  interested  in  measures  to  ensure 
safety  to  those  employed  in  dangerous  occupations,  will  take  the 
trouble  to  inform  themselves  by  visiting  the  shops,  they  will  find 
that  in  a  very  large  number  of  cases  provision  for  absolute  safety 


42  REPORT   OF   THE    COMMISSION 

has  been  made.  They  will  further  find  the  safety  appliance  out  of 
use,  because  of  the  singular  indifference  of  the  workman  to  his 
own  safety;  or  in  use,  by  reason  of  the  careful  supervision  of  the 
owner.  This  attitude  of  the  general  public,  not  only  in  the  shops 
but  in  all  the  everyday  affairs  of  life,  is  the  most  serious  discour- 
agement the  workers  for  a  better  social  condition  have  to  contend 
with.  To  disregard  all  efforts  toward  safeguarding  the  employee 
because  of  his  indifference,  cannot  be  tolerated.  No  man  in  the 
community  belongs  to  himself.  During  health  he  may  have  the 
mistaken  notion  that  he  does,  but  if  he  is  injured,  he  in  the  vast 
majority  of  cases  becomes  a  public  charge.  Aside  from  all  altru- 
istic motives,  the  safety  appliances  are  to  the  advantage  of  the 
community,  from  an  economic  point  of  view,  and  their  use  should 
be  required. 

Full  justice  is  seldom  done  to  manufacturers  in  such  matters. 
Most  men,  if  shown  that  any  measure  will  be  a  decided  advantage 
to  their  employees  in  health  or  safety,  will  adopt  it,  even  at  con- 
siderable expense  to  themselves.  The  average  manufacturer 
thinks  more  for  the  health  and  safety  of  his  employees  than  the 
average  worker  does  for  himself,  and  safeguards  provided  by 
them  are  often  disregarded  or  thrust  aside  by  their  employees. 

In  the  hat  industry,  the  introduction  of  the  kiln  system,  as  well 
as  the  substitution  of  denatured  alcohol,  has  greatly  reduced  the 
danger  from  alcoholic  fumes.  Formerly  the  hats  were  dried  on 
racks,  and  the  men  who  had  to  work  in  these  rooms  and  take 
out  the  dry  hats  were  frequently  overcome  by  the  fumes.  In 
some  instances  blindness  resulted  from  this  exposure.  Now  the 
hats  are  dried  in  kilns  and  the  fumes  exhausted  and  the  alcohol 
reclaimed. 

Owing  to  the  greatly  varying  circumstances  in  factories,  it  is 
impossible  to  provide  a  law,  in  respect  to  working  conditions, 
which  shall  apply  to  all  alike.  What  would  be  very  good  in  one 
place  would  be  very  bad  in  another.  The  Massachusetts  Com- 
mission has  recommended  the  passage  of  a  law,  by  which  the 
factory  inspector  may  require  any  manufacturer  to  bring  the 
conditions  as  to  dust,  ventilation  and  sanitation  in  his  factory  up 
to  the  best,  where  there  are  similar  conditions  as  to  dust,  building 
and  employment,  allowing  an  appeal  from  the  decision  of  the 
factory  inspector.    Any  such  law  should  be  careful  to  protect  the 


FOR   THE    INVESTIGATION    OF   TUBERCULOSIS.  43 

manufacturer    against   improper    exactions,    particularly    in    the 
case  of  old  buildings,  but  is  worthy  of  consideration. 

Air  Space  per  Person.  Both  New  York  and  Massachusetts 
have  laws  which  require  a  minimum  of  two  hundred  and  fifty 
cubic  feet  of  air  space  per  worker.  In  New  York,  four 
hundred  are  demanded  where  there  is  night  work,  though  this 
provision  is  aimed  mostly  at  sweat-shops,  of  which  there  are 
practically  none  in  Connecticut.  It  is  a  fact  that  there  is  not 
much  overcrowding  in  our  factories,  yet  some  such  law  might  be 
of  value. 

Ventilation.  It  is  of  even  more  importance  that  the  air  in  • 
workrooms  should  be  changed  in  such  manner  as  to  provide  pure 
and  uncontaminated  air  to  the  workers.  The  best  modern  fac- 
tories are  provided  with  heating  apparatus,  which  supplies  an 
ample  amount  of  fresh  air  from  outside,  or  through  systems 
which  humidify  and  warm  the  air  at  the  same  time.  In  the  sum- 
mer there  is  plenty  of  ventilation  through  open  windows. 

Our  laws  provide  for  the  ventilation  of  all  workrooms,  and 
these  laws  are,  we  believe,  enforced  by  our  factory  inspector. 
Here  again,  we  do  not  have  to  contend  with  the  sweat-shop.  But 
there  can  be  much  done  to  improve  conditions.  Exhaust  fans 
carry  away  dust  and  at  the  same  time  provide  fine  ventilation. 
The  work  of  our  factory  inspector  in  this  direction  should  be 
cordially  supported  and  its  extension  helped. 

Sanitation.  The  Connecticut  law  as  to  sanitation  in  factories 
is,  in  the  main,  good  and  sufficient,  as  regards  plumbing,  closets 
and  cleaning  floors,  machinery,  etc.  The  New  York  law  gives 
the  factory  inspector  authority  to  order  walls  and  ceilings  lime- 
washed,  when  the  health  of  persons  working  may  be  affected. 
Connecticut  law  gives  this  power  in  bakeries.  It  might  well  be 
extended  to  all  factories. 

Bakeries.  The  Connecticut  law  in  respect  to  bakeries  is  excel- 
lent. No  new  bakeries  are  allowed  to  be  built  below  grade,  nor 
old  ones  that  have  been  closed  to  be  reopened.  Workrooms  must 
be  at  least  eight  feet  in  height,  the  walls  plastered  or  wainscotted, 
the  ceilings  plastered  or  ceiled  with  lumber  or  metal,  floors  and 
utensils  kept  clean  and  sanitary,  the  rooms  dry  and  airy.  Sleeping 
places,  also  all  closets,  ash  pits,  etc.,  must  be  separate  from  the 
workrooms.  The  inspector  might  be  given  the  additional  author- 
ity to  order  medical  inspection  of  all  persons  employed  in  bakeries. 


44  REPORT    OF   THE    COMMISSION 

and  the  same  law  entire  might  be  extended  to  cover  tobacco 
factories,  confectionery  shops,  and  all  factories  for  the  prepara- 
tion of  food,  and  shops  where  food  products  are  sold. 

Laundries.  The  New  York  law  makes  all  public  laundries 
factories,  and  subject  to  the  same  inspection  and  regulation  as 
other  factories.  It  also  prohibits  such  work  being  done  in  sleep- 
ing- or  living-rooms,  but  exempts  any  female  doing  custom 
laundry  work  at  home. 

Garment  Workers.  In  general,  all  places  where  people  work  in 
the  employ  of  others  should  be  subject  to  inspection  and  regula- 
tion. It  is  doubtful  how  serious  the  danger  may  be  from  clothing 
that  has  been  made  by  sufferers  from  tuberculosis.  Doubtless, 
there  is  some.  The  question  is  far-reaching,  and  it  is  doubtful 
whether  anything  short  of  physical  examination  of  all  persons 
employed  in  making  or  handling  cloth  and  clothing,  and  the 
exclusion  of  all  infected  persons  from  such  employment,  would 
much  lessen  such  danger  as  may  exist.  This  procedure  would 
work  very  great  hardship,  and  people  excluded  from  their  work, 
by  reason  of  such  physical  examination,  would  have  to  be  cared 
for  by  the  State  to  an  extent  hardly  to  be  expected.  It  would 
afford  no  protection  against  infection  from  clothing  made  out- 
side of  the  State.  We  do  not  think  that  such  a  step  has  been 
taken  anywhere  in  the  world. 

The  New  York  sweat-shop  law  is  most  voluminous  and  far- 
reaching  in  its  powers  to  disinfect,  condemn  or  quarantine  goods 
and  garments  made  in  infected  or  unclean  places,  and  if  enforced 
to  the  letter  would  be  most  drastic;  but  even  this  does  not  con- 
template anything  so  severe  as  excluding  from  employments,  of 
such  a  wide  range,  persons  infected  with  tuberculosis,  nor  do  we 
believe  it  to  be  necessary  or  advisable. 

Free  Bed  Funds.  No  report  on  factory  conditions  in  Con- 
necticut would  be  complete  which  did  not  mention  the  work  of 
the  Workingmen's  Free  Bed  Fund.  Started  first  in  Hartford  and 
promoted  largely  by  the  indefatigable  work  of  Mr.  John  Gun- 
shanan,  it  has  proved  to  be  a  work  of  great  value  to  the  working- 
men  of  that  city.  A  large  amount  of  money  has  been  raised  by 
subscriptions  from  the  men  in  the  shops,  which  has  been  applied 
to  the  care  of  workmen  suffering  from  tuberculosis  and  to  the 
relief  of  their  families.  This  plan  to  secure  funds  for  the  care 
of  the  tuberculous  and  for  the  maintenance  of  their  families  dur-. 


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FOR   THE    INVESTIGATION    OF   TUBERCULOSIS.  45 

ing  the  enforced  idleness  of  the  invalid,  has  already  been  adopted 
and  organized  in  most  of  the  large  cities  of  the  State  and  is  fast 
developing  into  a  work  of  magnitude. 

It  has  recently  been  reorganized  on  a  new  basis.  A  number  of 
groups  are  formed,  each  one  comprising  the  workers  of  one 
factory,  or  a  number  of  small  factories.  Each  group  is  to  have 
its  own  officers  and  a  fund  for  the  benefit  of  its  own  members. 
In  some  instances,  the  employer  has  agreed  to  contribute  a  sum 
equal  to  the  amount  contributed  by  the  employees.  These  funds 
are  devoted  to  the  care  of  workers,  or  their  families,  suffering 
from  tuberculosis. 

In  Germany,  the  government  requires  the  employer  to  deduct 
a  certain  amount  of  the  wages  of  the  employee,  to  place  with  it 
a  like  amount,  and  the  fund  so  created  is  used  for  sick  benefits 
and  kindred  purposes. 

In  some  factories  in  this  country,  a  similar  arrangement  is  in 
operation,  each  worker  being  asked  to  allow  so  much  to  be 
taken  from  his  wages,  the  employer  adding  an  equal  amount, 
which  forms  the  basis  of  a  fund  to  be  used  for  sick  benefits. 
It  is  possible  that  some  such  arrangement  might  take  the  place 
of  the  subscription  paper,  as  a  means  of  raising  money  for  the 
Free  Bed  Funds. 

This  movement  to  secure  an  organized  effort  throughout  the 
State,  to  establish  and  maintain  a  sick  relief  fund  for  the  care 
of  the  tuberculous  and  their  families,  is  worthy  the  unusual  atten- 
tion. It  goes  far,  if  it  can  be  maintained,  toward  meeting  the 
serious  loss  that  comes  to  every  man  from  tuberculosis.  It  affords 
him  the  opportunity  for  securing  proper  treatment,  and  aids 
immeasurably  in  that  treatment  by  caring  for  his  family  and 
thus  relieving  the  mental  anxiet}^  that  is  otherwise  unavoidable. 
The  German  method  of  sick  and  invalid  insurance  has  been  in 
operation  now  since  1884,  a-i^d  the  accompanying  chart  shows  very 
graphically  what  has  resulted,  largely  from  the  influence  of  that 
movement.  The  present  compulsory  insurances  now  in  force  in 
Germany  are 

1.  Accident  Insurance  (came  into  force  July  6th, 
1884).     Provided  for  by  payment  from  employers  only. 

2.  Sickness  Insurance  (came  into  force  December  i, 
1884).  Provided  for  by  payment  from  workmen  two- 
thirds,  from  employers  one-third. 


46  REPORT    OF    THE    COMMISSION 

3.  Invalidity  and  old  age  insurance  (in  force  Janu- 
ary, 1891).  Provided  for  by  payment  from  workmen, 
emplo3^ers  and  the  state. 

This  sickness  insurance  subjects  to  compulsory  insurance  all 
worl<men  over  sixteen  years  of  age,  who  are  employed  in  mines, 
quarries,  factories  or  other  industrial  concerns,  provided  that  in  all 
cases  the  annual  earnings  do  not  exceed  $500.  To  illustrate  the 
operation  of  the  law.  Dr.  Bulstrode  says:  "An  insured  workman 
having  a  weekly  wage  of  $6.00  pays  12  cents  weekly  toward  the 
Insurance  fund.  In  case  of  sickness  he  receives  $3.00  per  week 
together  with  free  medical  attendance  and  medicine.  In  the 
event  of  death  the  burial  money  would  amount  to  $19.50.  In 
addition  to  those  rights  gratuitous  medical  attendance  is  fre- 
quently granted  to  the  family."  This  question  of  industriad  insur- 
ance is  outside  of  the  work  of  the  Commission  and  is  far  too 
important  a  question  for  careless  discussion.  It  is  mentioned 
here  briefly,  as  in  its  operation  it  accomplishes  the  work  that  Mr. 
Gunshanan  has  inaugurated  in  our  State  upon  a  purely  volun- 
tary basis,  a  work  that  your  Commission  urgently  desires  to 
see  thoroughly  organized,  in  all  available  parts  of  the  State,  and 
for  which  it  bespeaks  the  careful  consideration  of  the  public. 

Providence  Factories.  An  interesting  work  is  being  carried  on 
in  the  factories  of  Providence,  R.  I.  The  employers  work  in  con- 
nection with  the  charity  organizations  and  help  them  to  find  the 
incipient  cases  of  tuberculosis,  one  of  the  most  difficult  things 
to  do.  The  following  notice,  or  a  similar  one,  has  been  posted 
in  the  factories : 

"There  is  at  present  a  strong  effort  being  made  to 
exterminate  the  disease,  consumption.  It  is  known  to  be 
readily  prevented  by  proper  ways  of  living.  The  hope- 
less or  incurable  cases  are  those  that  have  been  allowed 
to  go  neglected. 

"In  order  to  aid  in  this  matter,  we  have  provided, 
free  of  expense  to  our  employees,  a  physician  who  is 
especially  interested  in  this  disease,  and  who  can  advise 
about  the  best  treatment;  and  for  the  purpose  of  help- 
ing those  who  may  be  afflicted  and  protecting  others,  we 
shall  feel  free  to  suggest  an  examination  of  any  who  may 


FOR    THE    INVESTIGATION    OF   TUBERCULOSIS.  47 

possibly  have  symptoms  of  this  disease,  as  indicated  by 
coughing,  loss  of  appetite  or  weight.  If  the  lungs  are 
found  to  be  healthy,  there  is  then  no  need  to  worry ;  if, 
on  the  other  hand,  there  is  disease,  it  can  be  treated 
before  it  is  too  late." 

In  addition  to  the  above  notice,  each  room  foreman  is 
instructed  to  report  any  persons '  working  under  him  who,  he 
thinks,  might  need  examination  and  care.  It  is  made  plain  that 
the  information  is  not  to  be  used  as  a  basis  of  discharge  but 
help.  The  name  of  the  physician  is  not  posted;  he  generally 
acts  without  pay.  In  some  cases  tlie  employer  supports  or  helps 
the  patients  found  to  be  diseased,  during  treatment,  which  is  very 
often  given  to  the  patient  while  living  at  home.  The  work,  first 
started  at  The  Brown  &  Sharpe  Manufacturing  Company  and 
the  Wanskuck  Woolen  Mills,  has  been  extended  to  include  about 
thirty-five  employers  and  is  meeting  with  success. 

Food  and  Alcoholism.  An  eminent  authority  maintains,  that 
three- fourths  of  all  disease  is  caused, ,  directly  or  indirectly,  by 
bad  food  and  bad  cooking  (Huber).  Anyone  who  has  eaten  of 
the  messes  prepared  by  a  slovenly  housewife  might  be  prepared 
to  believe  it.  Such  persons  are  most  liable  to  have  recourse  to 
alcohol,  to  tide  them  over  an  unsatisfying  meal,  and  the  same 
authority  claims  that  eighty  per  cent,  of  the  alcoholics  become 
tuberculous.  Teach  the  wives  of  our  factory  workers  to  cook 
good  food  and  much  will  be  done  to  improve  their  general  health. 

Lunchrooms.  Some  of  the  factories  in  the  State  provide  lunch- 
rooms, where  a  caterer  is  allowed  to  sell  good  wholesome  food 
at  a  reasonable  price,  providing  the  workers  with  a  hot  meal  in 
place  of  a  cold  lunch,  the  former  being  much  more  healthy  and 
easily  digested.  Such  rooms  also  allow  of  the  working-rooms 
being  aired  during  the  noon  hour.  The  Underwood  Factory  of 
Hartford  has  probably  the  most  successful  of  these  lunchrooms 
in  size,  length  of  service  and  patronage.  This  factory  is  one  of 
the  best  in  the  State  and  has  worked  out  many  interesting 
problems. 

In  general,  the  conditions  in  Connecticut  are  equal  to  those  in 
any  other  state  and  the  manufacturers  are  quite  ready  and  willing 
to  do  whatever  is  necessary  to__make  them  the  best  anywhere  in 
the  world. 
■       4 


48  REPORT    OF    THE    COMMISSION 


THE  STATE  CARE  OF   INDIGENT 
CONSUMPTIVES. 


Public  sentiment  throughout  the  civihzed  world  has  been  fully- 
aroused  as  to  the  economic  crime  of  allowing  tuberculosis,  a 
preventable  disease,  to  destroy  annually  the  productive  value  of  a 
vast  army  of  workers.  How  to  meet  the  trouble  economically 
and  effectively  is  a  question  that  can  no  longer  be  disregarded. 
At  first  there  was  in  many  states  of  the  Union  a  demand  for 
the  construction  of  state  sanatoria  for  the  care  of  tuberculosis 
patients.  In  a  number  of  states  such  institutions  were  erected  and 
are  to-day  in  successful  operation.  All  experts  in  sanatorium 
work  are  now  agreed  upon  the  fact,  that  the  value  of  such  insti- 
tutions is  limited  and  the  number  of  beneficiaries  cannot  exceed 
one  hundred  and  fifty  in  any  one  institution  without  detriment. 
It  is  true  that  in  a  few  instances  sanatoria  have  been  increased  in 
capacity  up  to  three  hundred  and  fifty  beds,  but  such  a  large 
number  is  regarded  as  undesirable.  An  increase  beyond  that 
number  cannot  be  considered,  if  the  institution  is  to  be  conducted 
for  treatment  of  hopeful  cases.  It  is  important  to  make 
the  fact  clear  that  a  sanatorium  is  an  institution  designed  for 
the  cure  of  tuberculosis.  It  is  not  a  reception  hospital  for 
hopeless  cases.  The  incipient,  hopeful  cases  cannot  be  housed 
with  the  advanced  and  hopeless  with  any  reasonable  expectation  of 
success.  The  vast  number  of  cases  of  tuberculosis  under  present 
conditions,  the  constant  increase  in  that  number  that  is  assured, 
places  the  state  sanatorium  out  of  the  question  as  a  satisfactory 
solution  of  the  problem  of  tuberculosis  control.  It  is  idle  to 
suppose  that  any  state  could  construct  and  maintain  such  highly 
expensive  institutions,  in  numbers  sufficient  to  care  for  all  the 
demand  that  would  arise.  It  is  not  desirable,  even  if  it  were 
financially  justifiable.  The  sanatorium  undoubtedly  fills  an 
important  place  in  the  scheme  of  controlling  tuberculosis,  but  the 
all-important  question  for  the  State  is  how  to  care  for  the  large 


FOR    THE    INVESTIGATION    OF   TUBERCULOSIS.  49 

number  of  sufferers  from  tuberculosis  who  are  financially  unable 
to  care  for  themselves.  These  cases  are  not  only  numerous  in 
every  community,  but  they  are  increasingly  a  menace  to  the  public 
health  in  direct  proportion  to  the  degree  of  their  poverty.  The 
absolutely  poor  are  the  most  prolific  in  scattering-  abroad*  the 
infection,  and  are,  as  a  rule,  the  most  intractable  in  all  efforts 
for  sanitary  reform.  It  should  always  be  borne  in  mind  that  a 
large  part  of  this  extreme  poverty  is  the  direct  result  of  tubercu- 
losis. The  willing  worker,  after  he  is  infected  with  the  disease, 
works  until  he  drops.  His  failing  strength  curtails  his  productive 
value.  His  wages  decrease.  His  family  are  steadily  dispensing 
with  one  necessity  after  another  until,  in  the  weakened  condition 
that  inevitably  results,  they  offer  a  fertile  field  for  the  develop- 
ment of  the  germ  that  has  been  by  this  time  freely  scattered 
about  their  home.  By  an  intelligent  and  perfectly  feasible  super- 
vision of  the  public  health,  a  vast  number  of  these  innocent  suffer- 
ers might  have  avoided  infection  and  remained  self-supporting 
until  life  was  closed  by  natural  causes.  These  cases  are  suffering 
from  insanitary  conditions  that  they  are  not  able  to  control,  and 
their  care  is  a  responsibility  upon  the  State  that  cannot  be  shirked. 
How  can  these  cases  be  cared  for  most  economically  and  at  the 
same  time  with  due  consideration  for  their  comfort  and  possible 
cure  ? 

It  is  a  self-evident  proposition  that  to  be  able  to  care  for  such 
cases  as  require  state  aid,  it  is  necessary  to  know  who  and  where 
they  are.  For  a  proper  understanding  of  conditions  in  any  com- 
munity, the  notification  and  registration  of  indigent  cases,  already 
alluded  to,  is  of  the  utmost  importance.  In  fact,  without  such  a 
systematic  enrollment  of  cases,  satisfactory  work  in  controlling 
the  spread  of  the  disease  is  impossible.  Cases,  once  discovered, 
should  be  kept  under  observation.  This  is  not  in  many  cases  an 
easy  task  with  the  extremely  poor,  as  they  are  so  constantly 
changing  their  rooms.  It  is,  however,  absolutely  necessary  that 
every  change  should  be  immediately  reported  and  the  vacated 
quarters  should  be  thoroughly  disinfected  by  the  local  health 
authorities.  This,  let  it  be  distinctly  understood,  the  health  officers 
are  at  the  present  time  authorized  and  willing  to  do,  and  neglect 
is  due  to  carelessness,  or  indifference  in  reporting  the  case  upon 
the  part  of  the  physician. 


5©  REPORT    OF    THE    COMMISSION 

The  only  effective  measure,  for  intelligent  treatment  of  the  con- 
ditions under  discussion,  is  through  the  free  dispensary  and  visit- 
ing nurses.  The  noble  work  that  these  agencies  are  at  present 
effecting  in  our  own  State  is  worthy  of  the  greatest  praise,  and 
yet  jt  is  known  to  comparatively  few  that  in  our  leading  towns 
such  institutions  even  exist.  Through  the  dispensary,  indigent 
patients  can  secure  such  advice  and  treatment  as  their  condition 
may  require,  and  such  cases  can  be  subsequently  kept  under  obser- 
vation by  the  visiting  nurse.  She  shows  them  how  to  care  for 
themselves,  how  to  cleanse  their  rooms  and  to  keep  them  clean. 
She  teaches  them  what  the  value  of  fresh  air,  sunlight  and  water 
is.  She  protects  the  family  against  the  infection  that  without 
her  intervention  is  almost  sure  to  occur.  For  the  patient  she 
provides  the  milk  and  eggs  and  nourishing  food,  and  where  pos- 
sible, the  comforts  that  may  in  a  degree  lighten  the  burden  and 
even  lead  to  recover}'.  The  beneficent  work  of  these  free  dis- 
pensaries and  visiting  nurses  cannot  be  exaggerated.  Quietly, 
unostentatiously,  sustained  by  a  sense  of  duty  and  a  love  of  the 
service  they  render  to  their  patients,  these  nurses  work  in  the  com- 
munity, often  beyond  the  limit  of  their  strength.  In  every  city 
and  town  of  sufficient  size  to  require  such  service,  the  dispensary 
and  the  visiting  nurse  should  be  established  and  liberally  main- 
tained. After  very  careful  investigation,  your  Commission  feels 
that  this  part  of  the  work  should  be  sustained  by  the  separate 
comm.unities  and  is  not  within  the  sphere  of  the  State's  respon- 
sibility. It  is,  however,  impossible  not  to  emphasize  the  impor- 
tance of  this  local  work  in  its  relation  to  state  control.  The  cost 
of  maintaining  these  dispensaries  and  nurses,  v/hen  brought  into 
comparison  with  their  achievements,  is  insignificant.  All  such 
work  to-day  is  sustained  by  private  charity,  and  those  devoted 
workers  who  secure  the  funds  to  maintain  it  have  many  hours  of 
anxiety.  The  funds  for  maintaining  this  work  should  come 
from  the  communities  that  are  directly  benefited,  and  a  liberal 
annual  appropriation  should  be  made  from  the  public  funds  for 
that  purpose. 

Wherever  it  is  possible  to  keep  the  tuberculous  patient  at  home 
and  to  control  the  danger  of  infection  through  the  cooperation  of 
the  trained  nurse  and  the  family,  it  is  manifestly  desirable  to  do 
so.  In  caring  for  cases  among  the  extremely  poor,  due  considera- 
tion must  be  shown  to  avoid  all  regulations  that  may  be  unneces- 


FOR   THE    INVESTIGATION    OF    TUBERCULOSIS.  5 1 

sary  and  may  add  to  their  already  heavy  burden.  It  is  often  the 
experience  of  the  visiting  nurse  to  find  a  patient  for  whom  care 
at  home  is  an  impossibihty.  If  it  is  essential,  in  order  to  provide 
for  a  family,  that  the  able-bodied  should  go  to  work,  it  is  often 
a  question  what  to  do  with  the  helpless  invaHd  at  home.  Is  this 
an  unusual  situation?  By  no  means.  It  is  the  daily  experience 
of  those  who  are  engaged  in  the  work,  and  it  can  be  truthfully 
asserted,  that  for  the  care  of  such  poor  and  helpless  consumptives 
there  is  no  place  in  Connecticut  to-day.  Town  authorities  all  over 
the  State  are  called  upon  to  provide  for  such  cases,  to  save  the 
whole  family  from  pauperism,  and  they  find  that  there  is  literally 
no  place  to  put  them.  The  town  farm  has  for  time  immemorial 
been  their  final  resting-place  upon  this  earth,  but  such  cases  can 
no  longer,  with  propriety,  be  so  cared  for.  In  some  towns,  very 
comfortable  accommodation  has  been  arranged  upon  the  town 
farms  for  a  limited  number  of  cases ;  but  the  public  mind  is  not 
in  sympathy  with  the  confinement  of  the  unfortunate  tuberculous, 
who  are  ill  largely  through  no  fault  of  their  own,  in  intimate  and 
prolonged  association  with  those  who  are  frequently  on  the  town 
by  reason  of  intemperance  or  inefficiency.  If  any  city  or  town 
constructs  a  separate  building  for  the  exclusive  care  of  the  tuber- 
culous, no  reasonable  objection  to  going  into  such  an  institution: 
can  be  sustained,  even  if  such  a  building  is  placed  in  the  neigh- 
borhood of  the  poorhouse. 

It  should  be  borne  in  mind,  in  considering  this  question,  that 
these  patients,  who  come  upon  the  care  of  the  public,  are  afflicted 
with  a  disease  that  is  often  slow  in  its  progress  and  may  continue 
for  a  prolonged  period.  At  the  same  time,  the  change  from  their 
tenement  to  a  suitable  environment,  with  good  food  and  relief 
from  mental  anxiety  as  to  those  dependent  upon  them,  may  so 
improve  their  condition  as  to  make  a  return  to  work  possible. 
In  not  a  few  cases  recovery  may  be  looked  for.  The  care,  then, 
of  these  indigent  cases,  is  such  as  should  be  extended  to  a  hospital 
patient  rather  than  to  a  pauper. 


52  REPORT   OF   THE    COMMISSION 


COUNTY  HOMES  RECOMMENDED. 


It  is  apparent  that  to  meet  the  situation  as  it  is  presented  to  the 
State  to-day,  there  must  be  some  suitable  place  selected  and  suit- 
able buildings  constructed  for  the  care  of  all  cases  of  tuber- 
culosis that  are  indigent  and  cannot  with  safety  be  cared  for  at 
home.  For  such  a  provision  for  the  tuberculous,  your  Commis- 
sion finds,  after  careful  investigation,  a  demand  upon  the  part  of 
the  public  that  cannot  be  disregarded.  It  would  appear  that  the 
most  economical  and  at  the  same  time  efficient  method  to  meet  the 
demand  will  be  in  the  construction  of  county  Homes  for  con- 
sumptives in  each  county  in  the  State.  It  is  at  the  outset  to  be 
understood,  that  in  proposing  such  a  measure,  your  Commis- 
sion is  not  recommending  the  construction  of  expensive  sanatoria, 
which  it  has  already  endeavored  to  make  evident  are  uncalled  for. 

If  this  work  is  to  be  undertaken  by  the  State,  it  should  be  done 
with  a  view  to  the  possible  cure,  or  material  betterment  of  the 
inmates.  It  should  be  understood  that  the  curability  of  tuber- 
culosis in  Our  own  climate  has  been  definitely  established.  Long 
years  of  training  in  a  contrary  opinion  has  so  influenced  the 
general  public  that  they  are  still  sceptical.  Within  the  borders 
of  every  county  in  Connecticut,  there  are  many  attractive  locations, 
healthful,  beautiful  and  well  adapted  to  the  modern  fresh  air 
treatment  of  consumptives.  Some  such  place  should  be  secured 
in  each  county  for  the  work  proposed.  In  making  such  selections, 
due  consideration  should  be  paid  to  proximity  to  the  larger 
centers  of  population;  not  near  enough  to  interfere  with  the 
purpose  of  the  institution,  but  as  near  as  possible,  in  order  to 
secure  to  friends  inexpensive  access  to  the  inmates. 

In  selecting  a  farm  for  such  an  institution,  it  is  desirable  that 
one  should  be  chosen  that  has  upon  it  good  farm  buildings,  in  a 
proper  state  of  preservation.  There  is  no  difficulty  whatever  in 
securing  such  farms  in  any  part  of  the  State  to-day,  and  the 
present  farm  house  and  outbuildings  will  easily  suffice  for  the 
offices  of  the  proposed  consumptive  Home. 


FOR    THE    INVESTIGATION    OF    TUBERCULOSIS.  53 

As  to  the  buildings  for  the  accommodation  of  the  patients,  two 
frame  buildings  of  simple  design,  one  for  male  and  the  other 
for  female  patients,  can  be  constructed  so  as  to  meet  every  require- 
ment. The  details  of  such  buildings  are  not  to  be  discussed  in 
this  report,  as  the  designs  will  necessarily  be  varied  to  conform  to 
the  location  and  to  the  expected  number  of  occupants.  In  a 
general  way,  it  may  be  stated  that  these  buildings  should  be  two 
stories  in  height,  the  first  floor  containing  a  ward  for  such  patients 
as  may  not  require  special  care,  the  second  floor  divided  into 
separate  rooms,  for  the  accommodation  of  those  who  are  confined 
to  their  beds.  A  double  piazza  can  be  made,  to  supply  out-of- 
door  rest  for  the  occupants  of  each  floor.  In  the  report  of  the 
Massachusetts  Commission  for  the  Investigation  of  Tuberculosis 
in  that  state,  it  was  estimated  that  such  buildings  might  be  con- 
structed for  $50,000  and  supply  accommodation  for  one  hundred 
patients.  A  county  Home  for  the  largest  counties  in  Connecticut 
would  require  this  capacity  at  the  outset,  while  in  the  smaller 
counties  much  less  would  be  called  for. 

Your  Commission,  in  making  this  suggestion  as  to  the  character 
of  the  Homes  recommended,  is  earnest  in  advocating  the  avoid- 
ance of  all  extravagance.  Built  simply,  as  suggested,  it  will  be  a 
matter  of  slight  expense  to  increase  accommodations  as  the 
demand  arises.  The  public  sanatoria  in  this  country  and  in 
Europe  are  built  upon  a  scale  of  magnificence,  in  many  instances, 
that  is  wholly  unjustifiable.  The  cost  of  maintenance  is  very 
excessive  and  for  a  disease  of  the  character  of  tuberculosis  such 
ornamental  structures  are  most  unsuitable.  The  very  beautiful 
private  sanatoria  that  have  been  built  in  some  parts  of  this 
country  are  in  the  main  memorials,  and  the  feeling  of  the  builder 
has  found  expression  in  lavish  expenditure.  Such  institutions  it 
is  not  proper  to  criticise,  but  in  some  instances  their  maintenance 
has  become  a  serious  embarrassment.  The  simple  frame  building 
and  the  inexpensive  "shacks,"  now  so  much  commended  by 
workers  in  institutions  for  the  treatment  of  tuberculosis,  undoubt- 
edly seem  mean  by  the  side  of  stone  and  marble,  but  they  are  more 
comfortable  to  the  average  occupant.  If  there  is  money  to  spend, 
let  it  be  expended  in  the  care  of  the  patients  and  in  proper 
remuneration  of  the  attendants. 

An  argument  against  extravagance  may  seem  uncalled  for,  but 
in  all  public  work,  unless  checked  at  the  outset,  the  danger  of 


54  REPORT   OF    THE    COMMISSION 

attempting  too  much  is  well  understood.  A  first  expenditure  in 
excess  of  what  is  desirable  not  infrequently  brings  a  commend- 
able public  work  into  disrepute  and  seriously  imperils  its 
usefulness. 

The  resident  staff  requisite  for  the  proper  conduct  of  the  insti- 
tutions proposed  will  vary  in  accordance  with  the  service  required. 
In  the  smaller  counties,  a  matron,  assisted  by  nurses  when  their 
services  are  necessary,  will  easily  suffice.  The  occasional  medical 
attendance  that  may  be  called  for,  can  be  secured  and  can  be 
paid  for  at  the  rates  prevailing  in  the  neighborhood  of  the  Home. 
In  the  larger  counties,  a  resident  physician  will  be  called  for,  to 
superintend  the  institution  and  to  meet  the  emergencies  that  may 
arise  and  demand  immediate  professional  attention. 

A  majority  of  the  cases  that  will  be  cared  for  in  these  institu- 
tions will  be  found  to  require  only  such  attention  as  may  be 
necessary  to  comfort  and  the  suitable  direction  of  their  daily  life. 
For  the  cases  that  show  evident  improvement,  that  give  promise 
of  ultimate  cure,  patients  for  whom  sanatorium  treatment  is  desir- 
able, another  provision  will  be  made. 


FOR    THE    INVESTIGATION    OF    TUBERCULOSIS.  55 


HOW  CAN  THESE  HOMES  BE  BUILT? 


There  is  no  part  of  Connecticut  exempt  from  tuberculosis,  and 
no  part  where  there  will  not  be  some  demand  for  these  county 
Homes.  The  demand,  however,  will  be  vastly  greater  in  some 
counties  than  others.  While  New  Haven  and  Hartford  and 
Fairfield  counties  would  surely  require  hospitals  adequate  for  the 
care  of  at  least  one  hundred  patients  each,  Tolland  and  Windham 
would  be  cared  for  by  institutions  of  much  smaller  capacity.  This 
proposition  to  build  county  tuberculosis  Homes  is  involved  in  the 
great  public  question  of  the  proper  care  of  indigent  cases  of 
tuberculosis,  and  is  proposed  as  the  most  economical  and  vastly 
the  most  effective  system  for  its  solution.  It  must  be 
emphasized  that  every  government  in  the  civilized  world  to-day 
recognizes  the  responsibility  for  energetic  measures  to  control 
tuberculosis.  Many  efforts  have  been  made  to  devise  the  plan  that 
will  be  the  most  far-reaching  in  its  operation.  The  objection  to 
all  previous  measures  has  been  in  their  centralization  and  in  the 
great  expense  that  has  seriously  limited  their  influence.  The 
state  sanatorium  is  a  large  central  building,  easily  filled  by  nearby 
communities  and  totally  incapable  of  caring  for  the  large  number 
of  cases  for  whom  provision  is  contemplated  in  this  report. 

The  duty  of  the  State  to  share  in  the  cost  of  this  work  is  evi- 
dent. It  is  further  evident  that  a  large  part  of  the  cost  should 
come  from  the  region  most  benefited.  By  the  county  Home  plan, 
each  county  has  accommodation  for  its  own  patients,  and  if 
the  county  shares  the  cost  with  the  State,  the  expense  will  be 
justly  balanced.  If  each  county  purchases  a  suitable  farm  for 
the  proposed  consumptive  Home,  and  places  thereon  suitable 
buildings  for  the  use  of  the  administration  staff,  it  seems  to  be 
reasonable  to  advise  that  the  cost  of  the  construction  of  the 
Homes  in  question  should  be  borne  by  the  State. 

The  choice  of  location  for  these  Homes  should  be  subject  to 
the  approval  of  a  special  tuberculosis  commission ;  and  the  size 
of    the    buildings,    their    character    and    mode    of    construction, 


56        '  REPORT   OF   THE    COMMISSION 

should  be  controlled  by  the  same  authority.  If  Connecticut  is  to 
have  these  county  hospitals  for  tuberculosis,  it  should  see  to  it 
that  in  all  that  pertains  to  them,  in  their  construction  and  in  their 
future  maintenance,  there  is  intelligent  supervision.  There  are 
many  to-day  who  feel  competent  to  carry  through  such  a  proposi- 
tion, who  have  not  the  faintest  conception  of  what  should  be  done, 
aside  from  a  very  liberal  expenditure  of  public  funds.  In  some 
state  sanatoria,  expensive  alterations  have  been  immediately 
called  for,  after  the  reception  of  patients,  because  of  the  ignor- 
ance of  those  in  authority  as  to  the  proper  requirements  for 
successful  treatment. 

The  first  cost  of  these  hospitals  should  not  exceed  a  stated 
amount.  It  would  seem  just  for  the  State,  in  directing  their 
construction,  to  assume  the  cost,  as  has  been  already  stated,  the 
whole  allowance  from  the  State  for  any  given  county  not  to  exceed 
$10,000  for  each  50,000  inhabitants  or  fraction  thereof  in  the 
county.  Taking  New  Haven  County  as  an  example,  with'  a  popu- 
lation of  300,000  an  amount  will  be  assured  that  will  be  sufficient 
for  the  construction  of  the  buildings  that  have  been  proposed. 
It  has  already  been  stated  that  the  cost  of  the  site  of  the  hospital 
and  of  some  of  the  buildings,  if  suitable  buildings  for  the  purposes 
of  administration  are  not  already  on  the  property,  should  be  met 
by  the  county.  Owing  to  the  irregular  distribution  of  population 
in  the  State,  the  proposed  allowance  to  New  Haven  County  of 
$60,000  would  be  fully  required,  and  a  like  amount  would  be 
required  in  Hartford  and  Fairfield  counties.  In  the  other 
counties  it  would  be  excessive.  Through  the  proposed  appro- 
priation, based  upon  population,  a  just  distribution  of  the  State's 
funds  seems  to  be  assured. 

The  appropriation  herein  suggested  should  provide  comfort- 
able Homes  for  at  least  four  hundred  patients.  While  it  is  pos- 
sible that  the  building  of  such  institutions  for  the  accommodation 
of  one  hundred  may  be  effected  at  the  cost  named  in  the  Massa- 
chusetts report,  this  estimate  can  only  be  regarded  as  approximate. 
An  appropriation  from  the  State,  made  upon  the  proposed  basis, 
for  the  construction  of  these  county  Homes  for  the  care  of  all 
stages  of  pulmonary  tuberculosis,  would  certainly  meet  a  great 
public  necessity,  at  a  cost  far  below  what  has  been  expended  in 
other  states  for  institutions  of  far  less  efficiency.  If  the  expendi- 
ture of  this  appropriation  is  entrusted  to  a  permanent  commission 


FOR    THE    INVESTIGATION    OF    TUBERCULOSIS.  57 

on  tuberculosis  the  State  will  receive  full  value  from  the  outlay 
and  probably  an  even  larger  provision  for  the  work  than  has  been 
estimated. 

It  should  be  remembered,  in  an}^  discussion  as  to  the  cost  of 
maintaining  these  proposed  Homes,  that  the  beneficiaries  of  such 
institutions  are  now  and  always  have  been  a  public  charge.  These 
indigent  consumptives  are  supported  in  poorhouses,  or  as  outside 
paupers.  They  are  wholly  dependent,  and  bringing  them  together 
in  some  institution  where  they  can  all  receive  suitable  care,  simply 
concentrates  effort  that  is  now  widespread  and  extravagant.  The 
actual  financial  value  to  the  community,  to  be  secured  through 
the  segregation  of  all  these  cases  of  helpless  sufferers  from  an 
infectious  disease,  cannot  be  stated.  It  will  mean  health  and  pro- 
ductive energy  to  thousands. 

The  Massachusetts  Commission  estimates  the  probable  per 
capita  cost  for  such  hospitals  at  from  $6  to  $8  a  week,  accord- 
ing to  the  location.  Prices  in  Connecticut  will  be  found  to  be 
much  the  same  as  in  Massachusetts. 

Reference  to  the  reports  of  charitable  institutions  in  Connecti- 
cut, that  have  heretofore  received  the  indigent  consumptives — hos- 
pitals excepted — would  seem  to  indicate  that  an  average  cost  of 
even  $7  per  week  was  excessive.  It  should  be  understood,  that  in 
calculating  the  per  capita  cost  for  the  care  of  the  inmates  of  a 
poorhouse,  the  cost  for  the  care  of  the  sick  is  immensely  reduced  by 
being  included  in  the  total  for  the  care  of  a  great  number  who  are 
simply  paupers,  receiving  mere  food  and  lodging  and  reducing  the 
expense  materially  by  rendering  service  in  the  institution.  The 
tuberculous  inmates  of  an  institution  cannot  be  relied  upon  for 
work,  require  good,  nourishing  food,  nursing  and  competent  med- 
ical service.  In  one  institution  in  the  State,  where  a  few  con- 
sumptives are  excellently  cared  for,  there  are  over  four  hundred 
other  inmates,  who  are  town  charges  by  reason  of  age  or  ineffi- 
ciency. These  really  able-bodied  people  do  practically  all  the 
work  of  the  house  and  farm,  and  can  thus  be  cared  for  at  a  cost  of 
little  over  $2  per  week.  Whatever  the  care  of  the  limited  number 
of  tuberculous  patients  in  this  institution  may  cost,  it  is  immensely 
reduced  in  making  the  estimate  when  the  whole  household  is 
included.  In  the  proposed  consumptive  Home,  most  of  the  labor 
must  be  hired  and  the  food  provided  must  be  of  entirely  different 


58  REPORT   OF   THE    COMMISSION 

quality  from  that  in  the  poorhouse,  even  where  there  is  no  cause 
for  criticism  in  the  poorhouse  management.  The  people  of  Con- 
necticut, if  they  provide  relief  for  the  tuberculous,  will  wish  such 
relief  to  be  given  in  the  hope  of  returning  the  invalid  to  work,  or 
in  mitigating  his  suffering  during  the  remainder  of  life. 

Whatever  the  cost  may  be,  it  is  desirable  that  all  beneficiaries 
of  these  consumptive  Homes  should  be  required  to  pay  something 
toward  their  care.  It  is  the  belief  of  your  Commission,  that  such 
institutions  should  be  so  conducted  as  to  avoid  the  taint  of  pauper- 
ism. Many  of  those  who  will  be  forced  to  seek  assistance  are  not 
paupers,  have  always  been  industrious  and  thrifty,  until  prolonged 
illness  has  exhausted  their  savings  and  forced  them  to  appeal  for 
aid  from  the  public.  At  the  present  time  such  people  are  depen- 
dent upon  private  charity  and  town  aid,  and  what  they  receive 
simply  prolongs  mental  and  physical  agony,  while  the  helpless 
family  sink  lower  and  lower,  until  they  are  too  often  paupers  in 
truth.  These  people  are  not  paupers  in  spirit.  Let  our  State  see 
to  it  that  they  are  not  made  so  in  fact,  by  reason  of  suffering  that 
the  State  can  alleviate.  Your  Commission  feels  that  such  patients 
should  be  required  to  pay  for  their  treatment  in  the  consumptive 
Home  at  least  $2  per  week.  If  the  town  authorities  know  that 
they  can  pay  more  than  that,  it  should  be  left  discretionary  with 
the  town  agent  to  charge  what  he  believes  to  be  reasonable,  or 
to  receive  them  free  of  cost. 

It  has  been  said,  in  criticism  of  this  charge  for  treatment,  that 
there  are  some  absolutely  destitute  in  every  town,  who  could  not 
pay  anything  and  for  whom  the  sick  benefit  associations  are  not 
willing  or  obligated  to  pay.  Such  cases  must  be  left  to  the  discre- 
tion of  those  having  the  town  poor  in  charge.  It  is  possible  that 
there  may  be  some  such  cases,  when,  without  fault  of  their  own, 
the  destitution  and  friendlessness  is  absolute,  but  they  are  very 
few  in  number  and  for  such  the  town  may  provide.  Most  of  these 
extreme  cases  are  broken-down  drunkards,  prostitutes  and  worth- 
less. They  are  from  the  criminal  and  degraded  classes.  Such 
should  be  decently  cared  for  as  town  paupers,  as  they  are  to-day. 
The  occupants  of  a  consumptive  hospital,  where  long  residence 
and  intimate  association  is  inevitable,  should  be  protected  from 
the  enforced  society  of  such  people.  The  fear  of  such  inter- 
course is  to  the  worthy  poor  to-day  one  of  the  heaviest  burdens 
they  have  to  bear. 


FOR   THE    INVESTIGATION    OF   TUBERCULOSIS.  59 

If  the  patients  pay  a  weekly  charge  of  $2,  the  balance  of  the  cost 
should  be  divided  equally  between  the  State  and  the  county  to 
which  the  patient  is  accredited.  Taking  $7  per  week  as  a  possible 
average  of  cost,  the  patient  will  pay  $2,  the  State  $2.50,  the  county 
$2.50.  The  cost  to  the  towns  for  their  tuberculous  poor  will 
not  be  more  than  it  averages  to-day,  if  they  are  obliged  to  assume 
the  charge  made  to  the  patient.  The  cost  to  the  State  will  amount 
to  a  sum  vastly  under  what  is  being  paid  by  many  states  to-day, 
while  the  accommodations  provided  through  the  proposed  plan 
will  far  exceed  what  is  being  provided  elsewhere.  Many  cases 
will  desire  care  in  these  Homes  that  are  able  to  pay  the  full  cost 
and  will  willingly  do  so.  The  regulation  of  this  question  will  be 
necessarily  left  to  the  decision  of  those  to  whom  the  responsibility 
for  regulating  the  management  of  the  Homes  is  referred  by  the 
Legislature. 


6o  REPORT   OF   THE    COMMISSION 


SANATORIUM  TREATMENT. 


The  Homes  that  have  been  proposed  in  this  report  are  designed 
for  the  reception  of  all  cases  requiring  public  assistance  and  are 
not  to  be  considered  sanatoria.  A  sanatorium  is  "an  institution 
in  which  patients  are  received  who  are  supposed  to  be  cura- 
ble. They  are  received  specifically  for  treatment.  Under  good 
management  and  when  judgm^ent  is  shown  in  selecting  the  cases, 
there  are  many  sanatoria  to-day  curing  tuberculous  patients,  and 
returning  to  active  life  many  who,  but  for  the  treatment,  would 
have  gone  on  to  hopeless  invalidism  and  death.  The  greatest 
embarrassment  that  such  institutions  have  to  meet,  is  in  the 
demand  for  admission  that  comes  from  all  quarters  from  unfavor- 
able cases.  Another  serious  question  in  sanatorium  work  is,  what 
to  do  with  patients  who  have  been  received  under  pressure  usually, 
and  who  are  so  advanced  as  to  be  helpless  and  a  constant  source 
of  anxiety  to  those  associated  with  them.  It  is  especially  for  such 
cases  that  the  county  tuberculosis  Homes  have  been  proposed.  In 
the  Homes  there  will  be  found  many  such  cases,  that  under  rest 
and  good  food  and  pure  air  will  improve  and  will  show  evidence 
of  ultimate  recovery,  if  they  can  be  under  suitable  guidance. 
Such  cases,  as  they  occur,  should  be  given  every  opportunity  for 
receiving  scientific  treatment.  They  are  too  poor  to  go  to  what 
are  supposed  to  be  more  desirable  climates.  They  are  just  as 
much  a  public  charge  as  they  were  when  they  were  forced  by  ill- 
ness to  enter  the  Home.  Their  cure  is  a  public  gain.  For  such 
cases,  sanatorium  treatment  is  most  desirable  and  should  be 
provided,  if  possible.  It  is  to  be  emphasized  that  the  Homes 
have  the  first  claim  and  their  construction  is  to  be  earnestly 
advocated.  It  is  further  to  be  emphasized  that  these  Homes  are 
not  to  be  regarded  as  Homes  for  incurables — as  very  many  of  the 
inmates  will  undoubtedly  be  able  to  return  to  work  after  a  few 
months. 

The  sanatorium  treatment  in  Connecticut  has  already  been  pro- 
vided, through  the  construction  of  the  Gay  lord  Farm  Sanatorium 


FOR    THE    INVESTIGATION    OF    TUBERCULOSIS.  6 1 

at  Wallingford  (the  property  of  the  New  Haven  County  Anti- 
Tuberculosis  Association),  and  through  the  Wildwood  Sanatorium 
in  Hartford  (the  property  of  the  Hartford  City  Hospital,  but  at 
the  present  time  conducted  as  a  separate  institution,  with  a  resi- 
dent medical  superintendent).  Both  of  these  institutions  came 
into  existence  as  private  charities,  the  State  having  assisted  by  the 
appropriation  of  $25,000  to  each  association  after  the  institutions 
were  established  and  in  process  of  construction.  The  Gaylord 
Farm  Sanatorium,  while  it  received  this  sum  from  the  State  to 
assist  in  its  development,  represents  an  investment  of  over  $100,- 
000,  contributed  by  citizens  of  New  Haven  County.  These  two 
institutions  are  well  adapted  to  receive  and  care  for  the  suitable 
cases  that  may  be  encountered  in  the  county  Homes.  They  con- 
tain one  hundred  and  ten  beds — sixty  in  Wallingford  and  fifty  in 
Hartford.  It  has  been  the  purpose  of  the  directors  of  these  insti- 
tutions, that  they  should  be  conducted  as  charities,  and  the  charge 
made  for  treatment  has  never  approximated  to  the  cost.  The 
deficit  that  has  occurred  each  year  has  been  met  by  private  sub- 
scription and  an  allowance  from  the  State.  The  State,  by  con- 
tinuing its  appropriation  at  such  ratio  to  the. cost  as  the  work  may 
require,  will  be  possessed  of  adequate  sanatorium  privileges  at 
comparatively  small  cost.  There  is  no  reason  why  these  two  insti- 
tuitions  should  not  be  increased  as  the  demand  arises.  Their 
increase  within  reasonable  proportion  is  only  a  matter  of  cost.  It 
should  be  emphasized,  that  the  care  of  patients  in  these  institutions 
is  extremely  expensive,  as  compared  to  the  cost  in  other  charities. 
The  patients  are  making  an  effort  to  overcome  a  wasting  disease 
and  require  the  best  of  nourishing  food.  Scientific  medical  atten- 
tion from  a  resident  specialist  is  indispensable.  In  every  way,  to 
make  the  work  a  success,  outlay  of  money  is  unavoidable.  The 
beneficiaries  of  sanatoria  of  this  character  are  required  to  pay  a 
considerable  part  of  the  cost.  The  work  is  entirely  unlike  the 
work  of  the  proposed  Homes.  The  curable  patient  in  the  sana- 
torium expects  to  return  to  work.  For  such,  friends  can  render 
assistance  with  expectation  of  return.  The  State  can  divide  a  cer- 
tain portion  of  the  sanatorium  cost  with  the  town  from  which  the 
patient  comes — the  balance  the  patient  must  pay.  Connecticut 
can  well  afford  to  pay  an  adequate  annual  allowance  to  these  insti- 
tutions, when  it  is  understood  that  in  this  State  there  is  to-day 
sanatorium  provision  for  tuberculosis  fully  equal  in  capacity  to 


62  REPORT    OF   THE    COMMISSION 

most  Other  states  and  built  at  a  cost  of  $50,000  to  the  State, 
about  one  quarter  of  what  would  have  been  expended  by  the 
State  for  such  accommodations,  if  private  citizens  had  not 
assumed  the  responsibility. 

The  deep  interest  that  has  been  felt  in  this  work,  especially  in 
Wallingford,  insures  a  broadening  of  its  influence  and  a  greater 
material  development  as  the  work  goes  on.  Left  to  private  super- 
vision, the  State  is  free  of  the  cost  and  care  of  supervision,  while 
through  its  annual  appropriation  toward  the  deficit,  it  secures  ade- 
quate sanatorium  work  for  its  citizens  at  small  cost.  For  example, 
the  appropriation  voted  by  the  last  Legislature  for  the  Wallingford 
Sanatorium  was  $7,500  per  annum.  The  work  of  the  institution 
has  been  carried  on  at  its  full  capacity,  and  the  per  capita  cost 
to  the  State  has  been  somewhat  under  $2  a  week  for  each  patient. 
The  balance,  over  and  above  charge  to  the  patient,  has  been 
contributed  by  private  charity.  These  private  sanatoria  receiving 
State  aid  are  the  most  economical  and  satisfactory  solution  of 
the  sanatorium  question.  If  other  associations  of  a  private  char- 
acter should  establish  a  sanatorium,  fully  equipped  through  sub- 
scription and  located  in  a  suitable  spot  where  there  wa-s  no  reason 
to  suspect  hostile  competition  as  a  motive,  it  would  be  proper  for 
the  State  to  assist  in  the  maintenance  of  such  work,  if  the  neces- 
sity for  its  existence  is  made  clear  to  a  competent  board,  who 
should  keep  supervision  upon  all  such  matters. 

To  the  State  the  highest  value  to  be  derived  from  sanatorium 
treatment  is  in  the  educational  influence.  The  cured  patient  goes 
to  his  home,  instructed  in  all  that  makes  for  good  health  and 
intelligent  personal  care.  He  has  experienced  the  evil  of  tuber- 
culosis, knows  what  it  means,  and  makes  every  effort  to  preserve 
the  health  that  his  residence  in  the  sanatorium  has  given  him. 
Such  a  man  is  a  teacher  of  sanitary  living  in  his  community.  He 
is  a  most  important  factor  in  the  work  of  suppressing  tuber- 
culosis. He  not  only  refuses  to  live  as  he  was  wont  to  do  before 
his  illness,  but  he  teaches  others  to  follow  his  advice  and  profit 
from  his  experience.  The  sanatorium  is  a  school  in  right  living, 
and  as  such,  returns  to  the  State  a  hundredfold  its  cost. 

No  assistance  should  ever  be  granted  by  the  State  to  an  asso- 
ciation that  is  not  incorporated  under  the  laws  of  the  State  and 
is  not  absolutely  free  of  all  possible  suspicion  of  commercialism. 


FOR   THE    INVESTIGATION    OF   TUBERCULOSIS.  63 

As  matters  stand  to-day,  if  the  county  Homes  are  provided  and 
the  two  sanatoria  are  generously  supported  in  their  work,  the 
provision  for  indigent  tuberculosis  patients  in  Connecticut  will 
be  liberal  and  adequate  to  meet  any  demand  that  may  arise  for 
years  to  come.  Connecticut  will  be  recognized  in  the  front  rank 
of  states  trying  to  solve  the  problem  of  tuberculosis.  The  State 
will  ofifer  to  other  states  a  plan  that  for  simplicity,  economy  and 
the  broadest  possible  charity,  surpasses  all  that  has  yet  been  done 
in  the  war  against  the  Great  White  Plague. 


64  REPORT    OF    THE    COMMISSION 


RELATION  OF  TUBERCULOSIS  TO  CATTLE 
INDUSTRY. 


So  many  investigations  have  been  published  upon  the  milk 
question,  by  unquestioned  scientists,  which  are  in  direct  contra- 
diction, that  an  earnest  seeker  after  the  truth  hardly  knows  what 
to  believe.  Zvlany  are  inclined  to  question  the  importance  of  the 
measures  to  secure  purer  milk  and  to  denounce  them  as  unwar- 
rantable interference  with  an  important  business  interest.  What- 
ever differences  there  may  be  as  to  measures  to  secure  a  pure 
milk  for  the  community,  there  is  no  possible  question  as  to  the 
fact  that  impure  milk  is  an  active  agent  in  causing  ill  health.  The 
fact  that  epidemics  of  typhoid  fever,  scarlet  fever  and  other 
diseases  of  serious  import  to  the  well-being  of  society,  are  often 
directly  traceable  to  milk  contamination,  cannot  be  controverted 
and  is  sufficient  to  establish  the  right  of  the  State  to  investigate 
and  regulate  the  dairy  business.  It  is  chiefly  regarded  as  a  hard- 
ship when  it  interferes  with  the  sale  to  the  public  of  food  unfit 
for  consumption.  The  day  has  passed  for  discussion  as  to  the 
propriety  of  proper  legislation  upon  dairy  matters.  The  question 
now  is,  what  can  be  done  to  secure  pure,  wholesome  milk,  at  the 
lowest  possible  cost  to  the  consumer  and  at  the  same  time  protect 
the  financial  interests  of  the  producer.  It  is  not  oppression  of 
the  farmer  to  seek  to  secure  milk  free  from  impurity,  but  it  is  a 
movement  of  the  highest  interest  to  him,  in  which  he  should 
cheerfully  cooperate.  At  the  same  time,  it  is  utterly  unreasonable 
to  suppose  that  every  precaution  demanded  by  enthusiastic  sani- 
tarians can  be  complied  with,  and  a  suitable,  clean  milk  furnished 
to  the  public  for  the  same  price  as  now  exists  in  most  towns  of  the 
State.  I\Iuch  of  the  uncleanliness  now  existing  is  due  to  the 
extremel}'  low  price  of  milk,  that  makes  the  employment  of  suit- 
able farm  labor  prohibitive.  The  improvement  that  must  come 
must  be  paid  for  by  the  consumer. 

Within  a  few  years  public  interest  in  securing  pure  milk  has 
greatly  stimulated  the   development  of  m.odel  dairies,  in  which 


FOR    THE    INVESTIGATION    OF    TUBERCULOSIS.  65 

every  possible  precaution  is  taken  to  avoid  contamination.  The 
extreme  care  for  all  the  details  of  the  business  that  is  called  for 
in  these  dairies,  has  unavoidably  raised  the  price  of  their  milk 
and  cream  to  a  point  that  excludes  them  from  the  use  of  the 
general  public.  The  public-spirited  citizens,  who  have  invested 
a  large  amount  of  capital  in  model  dairies  and  have  persevered 
in  their  effort,  often  at  considerable  loss,  have  done  an  important 
service  to  the  State.  Their  example  has  unquestionably  aroused 
a  general  interest  among  dairymen  to  improve  the  quality  of  their 
products.  While  this  influence  of  the  model  dairy  does  much 
to  improve  the  general  output  of  milk,  the  cost  of  first  grade 
milk  is  to-day  prohibitory.  It  is  for  the  State  to  see  that  regula- 
tions of  the  dairy  business  are  such  as  to  secure  for  public  use 
reasonably  pure  milk,  at  a  price  that  will  insure  a  fair  return  to 
the  producer.  The  magnitude  of  this  undertaking  is  not  appre- 
ciated by  many  who  are  ardent  and  often  injudicious  in  their 
demands  for  immediate  reform.  When  it  is  understood  that  in 
New  York  City  the  daily  consumption  of  milk  amounts  to  one  and 
a  half  million  quarts,  that  of  this  vast  amount  only  sixteen  thou- 
sand quarts  are  "certified"  as  pure  milk,  that  the  main  supply 
comes  from  thirty-five  thousand  farms,  scattered  over  many 
states,  that  it  is  handled  over  and  over  again  unavoidably,  it  must 
be  admitted  that  the  utmost  judgment  and  practical  sense  are 
called  for  to  meet  the  situation.  No  one  with  a  proper  under- 
standing of  thq  situation  can  for  a  moment  believe,  that  by  any 
legislative  enactment,  all  the  farms  in  the  State  could  be  imme- 
diately transformed  into  model  dairies.  There  are,  however,  two 
very  important  questions  that  call  for  serious  consideration ;  first, 
the  proper  care  of  cattle  upon  all  farms  and,  second,  the  wisest 
action  to  take  in  the  effort  to  suppress  bovine  tuberculosis. 

It  is  only  within  a  few  years  that  the  owner  of  cattle  has  had 
any  state  supervision.  For  two  centuries  and  more,  farmers  cared 
for  their  cattle  or  neglected  them,  and  were  in  no  way  responsible 
for  their  act  to  anyone.  Barns  were  built  all  over  Connecticut,  a 
hundred  years  or  more  ago  in  many  instances,  in  which  no  pro- 
vision was  made  for  light,  air  or  cleanliness.  Cows  stood  in  their 
manure,  in  dark  stalls,  only  ventilated  and  lighted  by  the  cracks 
in  the  barn  walls.  Milking  was  done  in  the  midst  of  such  con- 
ditions and  the  milk  allowed  to  stand  for  hours,  until  it  suited  the 
convenience  of  the  owner  to  remove  it.     Such  was  the  condition 


66  REPORT   OF   THE    COMMISSION 

of  affairs  in  the  past  and  such  it  is  to-day  in  many  instances. 
Throughout  the  State  it  is  probably  fair  to  estimate  the  present 
care  of  cattle  as  five  per  cent,  perfect,  twenty  per  cent,  good,  fifty 
per  cent,  fair,  and  the  remaining  twenty-five  per  cent,  infamous. 
Those  who  are  taking  intelligent  care  of  their  stock  are  reason- 
able, and  ready,  as  a  rule,  to  comply  with  any  reasonable  sugges- 
tions for  their  improvement.  The  opposition  to  dairy  inspection 
and  all  efforts  to  secure  better  conditions  comes  invariably  from 
that  twenty-five  per  cent,  who  produce  their  milk  under  condi- 
tions of  filth  that  is  almost  inconceivable.  A  considerable  pro- 
portion of  these  negligent  farmers  are  foreigners,  largely  from 
Southeastern  Europe,  who  have  recently  come  to  this  country  and 
have  been  aided  by  charitable  societies  to  take  up  farms  through- 
out Connecticut.  These  people  are  not  familiar  with  our  institu- 
tions and  not  infrequently  regard  the  comparative  freedom  from 
state  supervision  in  this  country  as  encouragement  to  license. 
These  abuses  in  dairy  management  are  susceptible  of  correction, 
and  efforts  in  that  direction  will  in  due  time  be  supported  by  all 
the  better  citizens  in  the  State.  The  present  movement  for  the 
suppression  of  bovine  tuberculosis  throughout  the  country,  has 
given  new  interest  to  the  question  of  advanced  dairy  farming,  and 
the  time  has  arrived  for  the  State  to  act;  first,  to  secure  proper 
conditions  for  all  cattle,  as  a  measure  imperatively  required,  if 
any  headway  is  to  be  made  in  the  battle  with  tuberculosis ;  and 
second,  to  secure  the  proper  care  of  tuberculous  stock. 

The    State    should    require    compliance    with    the    following 
regulations : 

1.  Cattle  should  be  suitably  housed  and  cared  for. 

2.  All  persons  employed  as  milkers  and  at  work  about  the 
stable  should  be  cleanly  and  of  good  personal  habits. 

3.  Milking  should  be  done  in  a  cleanly  manner  and  the  milk 
should  at  once  be  suitably  treated. 

4.  Every  effort  should  be  made  to  secure  rapid  transporta- 
tion and  rapid  and  sanitary  distribution  of  the  milk. 

5.  Any  cow  known  to  be  sick  should  be  isolated  from  the  herd 
and  its  milk  should  not  be  used  during  its  illness.  In  case  of 
chronic  or  contagious  diseases,  not  susceptible  of  treatment,  the 
cow  should  be  killed  and  its  remains  so  disposed  of  as  to  ensure 
safety  for  the  remainder  of  the  herd. 


FOR    THE    INVESTIGATION    OF    TUBERCULOSIS.  67 

6.  Cows  known  to  be  suffering  from  tuberculosis,  the  diag- 
nosis having  been  made  by  physical  examination,  should  be  killed 
and  the  owner  should  receive  fair  value  from  the  State. 

7.  Cows  known  to  be  tuberculous,  by  tuberculin  test  only, 
should  not  be  used  for  dairy  purposes,  unless  the  milk  is  pasteur- 
ized.   Such  cows  should  be  isolated  from  the  rest  of  the  herd. 

8.  No  cows  should  be  allowed  to  be  brought  from  outside 
of  the  State,  unless  accompanied  by  a  certificate  of  health  from 
a  properly  constituted  state  official  of  the  state  from  which  she 
comes,  including  a  certificate  of  freedom  from  tuberculosis,  as 
shown  by  the  tuberculin  test. 

A  careless  perusal  of  these  regulations  may  lead  to  the  opinion 
that  they  are  burdensome,  but  they  are  simply  the  rules  that  are 
voluntarily  followed  by  all  good  dairymen  .in  the  State.  A  fuller 
consideration  of  each  of  these  regulations  will  be  profitable. 


68  REPORT   OF   THE    COMMISSION 


THE  HOUSING  OF  CATTLE. 


It  is  a  recognized  fact,  that  human  tuberculosis  is,  in  its  extent 
and  virulence,  in  direct  proportion  to  the  character  of  the  dwell- 
ing and  the  habits  of  life.  It  has  already  been  stated  that  this 
disease  is  found  in  the  most  sanitary  homes,  where  the  sufferer 
has  all  his- life  enjoyed  the  privilege  of  intelligent  care,  but  as 
the  environment  becomes  less  desirable,  the  frequency  of  the 
disease  increases,  until  it  is  found  in  its  most  virulent  and  per- 
sistent form  in  the  crowded  and  filthy  tenements  of  the  extremely 
poor  and  ignorant.  The  same  is  true  with  bovine  tuberculosis. 
The  rigid  inspection  of  all  herds,  now  practiced  by  advanced 
dairy  farmers,  by  means  of  the  tuberculin  test,  reveals  many  incip- 
ient cases  that  could  not  by  any  possibility  be  detected  by  the  usual 
physical  examination.  Some  herds  of  apparently  perfect,  high 
grade  cattle,  have  by  the  test  been  shown  to  be  infected  to  a 
degree  that  is  almost  incredible.  In  one  of  the  finest,  best  cared- 
for  herds  ever  owned  in  Connecticut,  there  was  hardly  one 
healthy  cow.  There  has  been  some  disposition  shown  to  dis- 
credit the  whole  effort  toward  the  scientific  care  of  stock  by 
reason  of  these  facts.  That  such  reasoning  is  faulty  can  be 
easily  shown,  by  examining  the  cattle  in  those  stables  in  which 
the  effort  to  eliminate  tuberculosis  has  been  persistently  con- 
ducted. Large  herds  can  be  shown  in  Connecticut,  in  which 
there  is  not  now  one  cow  that  will  react  to  the  tuberculin  test, 
while  investigation  into  the  condition  of  cattle  kept  in  insanitary 
stables  will  disclose  many  cases  of  generalized  tuberculosis, 
easily  recognized  without  examination. 

The  necessity  for  light  and  .well-ventilated  barns,  suitably 
drained,  is  self-evident.  The  arrest  of  bovine  tuberculosis  calls 
for  as  much  regard  for  such  conditions  in  the  care  of  cattle, 
as  does  the  present  fresh-air  treatment  of  human  tuberculosis. 
In  the  best  dairies,  cattle  are  kept  in  special  barns,  well  lighted, 
ventilated  and  drained,  without  cellars  or  upper  lofts.  Such 
arrangements  are  unquestionably  most  desirable  and  conducive 


FOR    THE    INVESTIGATION    OF    TUBERCULOSIS.  69 

to  the  general  well-being  of  the  stock.  It  is,  however,  mani- 
festly impossible  for  the  State  to  require  such  accommodations 
for  all  dairy  cattle.  Thousands  of  farmers  owning  small  herds, 
scattered  all  over  the  State,  own  barns  that  were  built  many 
years  ago.  Most  of  these  barns  are  up  to  the  standard  of  the 
day  in  which  they  were  built.  Many  were  and  are  still  provided 
with  what  were  supposed  to  be  the  most  advanced  conveniences. 
The  problem  now  is,  how  to  render  these  barns  suitable  for  the 
care  of  cattle,  how  to  rectify  errors  and  to  introduce  new  safe- 
guards to  protect  the  cattle  against  infection.  The  owners  are 
reasonable,  intelligent  men,  ready  to  do  their  part;  but,  as  a 
rule,  they  are  unable  to  command  the  capital  required  to  meet 
many  of  the  requirements  that  have  been  proposed  by  some  sani- 
tarians. The  old  barns  cannot  be  replaced — in  many  cases,  the 
cost  of  cement  flooring  is  prohibitory.  There  are  changes,  how- 
ever, that  are  called  for  in  almost  every  instance,  that  are  not 
oppressive  and  that  the  State  should  insist  upon  on  all  farms 
selling  milk. 

1.  There  should  be  an  immediate  stop  put  to  the  confinement 
of  dairy  cattle  in  windowless,  unventilated  apartments.  Light  and 
air  are  essential  to  health,  to  cleanliness,  to  common  decency. 
And  yet  there  are  to-day  thousands  of  cows,  crowded  into  dark 
rooms  and  cellars  throughout  Connecticut,  in  which  the  filth  is 
indescribable.  Windows  should  be  immediately  introduced  into 
all  such  barns,  sufficient  to  allow  four  square  feet  of  light  to 
each  cow.  If  the  stable  is  so  arranged  as  to  make  it  impossible 
to  comply  with  this  requirement,  it  is  not  suitable  for  the  health- 
ful care  of  cattle.  An  abundant  air  supply  is  of  equal  conse- 
quence. In  every  stable  there  should  be  sufficient  space  to  allow 
at  least  five  hundred  cubic  feet  of  air  to  each  animal. 

2.  The  stable  floors  should  be  tight  and  so  graded  as  to  be 
properly  drained.  To  ensure  clean  milk,  a  clean  floor  is  necessary. 
The  practice  of  keeping  cattle  in  barn  cellars,  where  they  stand 
upon  the  earth,  and,  by  reason  of  their  dejections,  are  practically 
knee  deep  in  liquid  manure,  is  nothing  less  than  criminal.  Such 
offensive  conditions  it  is  to  be  hoped  are  unusual,  but  they  do  exist 
in  an  aggravated  form  in  some  parts  of  the  State.  The  usual 
board  floors  are  not  clean  and  cannot  be  made  so.  The  wood  must 
absorb  much  filth  that  cannot  be  removed  by  the  most  scrupulous 
care.     The  fact  remains  that  most  of  the  barns  in  the  State  have 


70    '  REPORT   OF   fHE    COMMISSION 

board  floors,  and  a  change  to  the  modern  cement  floor  cannot  be 
made  without  placing  an  unreasonable  burden  upon  many  farm- 
ers. It  is  desirable  that  the  State  should  require  the  laying  of 
cement  floors  in  all  new  barns.  If  the  present  floors  are  made 
tight  and  evenly  laid  upon  a  grade  that  will  ensure  good  drainage, 
they  can  be  kept  reasonably  clean,  if  the  owner  is  disposed  to 
make  the  necessary  effort. 

3.  All  manure  should  be  removed  from  the  cow  stable  daily! 
It  should  be  stored  in  a  suitable  place,  from  which  drainage  back 
to  the  stable  would  be  impossible.  The  manure  of  a  stable  is  a 
valuable  asset  upon  every  farm.  The  small  extra  effort  required 
to  collect  and  store  it  in  a  suitable  manure  pit,  removed  from  the 
barn,  brings  an  appreciable  return  in  the  fertilizing  value  of  the 
manure.  In  some  barns,  the  manure  is  simply  hoed  carelessly 
away  and  left  in  a  pile  alongside  of  the  cows  throughout  the 
whole  winter.  In  one  case  inspected  by  the  dairy  commissioner, 
the  manure  was  not  only  stored  in  this  filthy  manner,  but  the 
morning's  milk  was  left  to  stand  in  this  odoriferous  stable 
throughout  the  day,  until  the  evening  milk  could  be  added  and 
the  whole  delectable  product  be  shipped  to  the  creamery,  there  to 
be  mixed  with  the  product  from  neighboring  farms,  upon  which 
every  effort  to  secure  clean  milk  may  have  been  made.  The  col- 
lected milk  of  a  creamery  is  little  better  than  the  worst  specimen 
included  in  the  lot — it  is  only  a  question  of  a  dilution  of  filth.  It 
is  not  true  that  such  conditions  are  approved  by  intelligent  and 
conscientious  farmers.  It  is  true  that  the  delinquent  in  the  case 
I  refer  to,  resented  the  invasion  of  his  personal  liberty  to  be  as 
nasty  as  he  pleased.  It  is  to  be  hoped  that  the  law  will  soon 
make  the  selling  of  such  milk  a  crime.  Some  years  ago,  in  con- 
structing model  barns,  it  was  the  approved  custom  in  some  sec- 
tions to  have  the  boards  back  of  the  stable  so  arranged  that  they 
could  be  raised  and  the  manure  could  be  easily  hoed  out  and 
dropped  into  the  cellar,  where  it  remained  all  winter.  This  con- 
dition is  not  unusual  on  good  farms  to-day.  It  is  not  cleanly 
and  is  not  wholesome.  It  most  seriously  interferes  with  the  pure 
milk  product  that  most  of  the  owners  of  such  barns  desire  to  put 
on  the  market.  The  air  in  such  barns  must  be  impregnated  with 
odors  that  the  milk  is  sure  to  absorb.  The  systematic  removal 
from  the  barn  of  all  manure  can  be  easily  accomplished  at  small 
cost  of  either  time  or  money.    The  present  carelessness  is  mainly 


FOR   THE    INVESTIGATION    OF   TUBERCULOSIS.  7 1 

the  result  of  an  established  habit  that  it  is  difficult  for  many  to 
overcome.  Education  and  the  force  of  public  opinion  will 
undoubtedly  tend  to  a  correction  of  the  evil  in  due  time. 

The  ceilings  of  cow  barns  should  be  tight  and  the  ceiling  and 
side  walls  and  stalls  should  be  whitewashed  at  least  once  in  six 
months.  In  case  of  sickness,  after  the  removal  of  the  cow,  the 
stall  should  be  thoroughly  scraped,  cleansed  with  boiling  water 
and  a  strong  solution  of  chloride  of  lime  and  whitewashed.  In 
the  barns  in  use  upon  fancy  dairy  farms,  such  a  procedure  is 
not  called  for,  as  the  woodwork  is  treated  in  such  a  way  as  to 
render  it  as  nearly  as  possible  asceptic.  Upon  the  average  farm, 
whitewash  is  needed  and  is  a  fairly  reHable  safeguard,  if  care- 
fully applied.  The  question  of  tight  ceilings  over  the  stalls  is 
one  of  some  difficulty,  as  matters  are  at  the  present  time.  Over 
many  stalls  occupied  by  cows  there  is  no  ceiling  at  all.  The 
space  is  open  to  the  roof,  or  a  roughly  constructed  support  holds 
the  hay,  not  far  above  the  cattle.  Such  construction  makes  cleanli- 
ness impossible.  Dust  of  all  kinds  must  sift  down  upon  the 
stock,  and  if  the  milking  is  done  in  the  stall,  such  dust  cannot 
be  kept  from  contaminating  the  milk.  The  cost  of  correcting 
this  construction  would  be  very  insignificant  and  it  should  be 
insisted  upon  on  all  farms  from  which  milk  is  sold  to  the  general 
public. 

Cows  should  occupy  the  same  stalls  and  should  not  be  turned 
into  the  stable  indiscriminately,  to  occupy  any  place  they  may 
chance  to  find  unoccupied.  The  object  of  this  procedure  is 
apparent.  It  is  a  well-recognized  fact  that  a  cow  may  be  danger- 
uosly  tuberculous  long  before  she  gives  evidence  of  ill  health. 
Under  such  conditions,  by  an  indiscriminate  use  of  the  stalls, 
she  can  readily  infect  the  whole  stable  and  imperil  the  entire  herd. 

Cows  should  be  thoroughly  cleaned  every  day.  This  cleaning 
should  be  done  at  a  time  and  in  a  manner  best  suited  to  protect 
the  milk  from  dust  contamination.  With  a  stable  suitably  lighted, 
aired  and  drained  and  properly  conducted  in  every  manner,  it  is 
obviously  impossible  to  protect  the  stock  from  a  certain  amount 
of  filth.  In  far  too  many  stables  such  matter  can  be  seen  dried 
and  encrusted  upon  the  cattle,  clearly  showing  that  no  effort  had 
ever  been  made  to  clean  them.  Microscopical  examination  of  the 
foreign  matter  in  market  milk  has  frequently  disclosed  fasces  and 
other  repulsive  substances,  that  might  have  been  avoided  had  the 
6 


72  REPORT    OF   THE    COMMISSION 

COWS  been  suitably  cleaned.  It  is  possible  that  this  suggestion 
as  to  regular  cleaning  of  cattle  may  be  extremely  irritating  to  the 
ordinary  farmer.  In  the  hurry  of  work,  it  is  true  that  the  horses 
are  liable  to  go  uncurried  for  a  long  time.  Why  then  devote 
so  much  time  to  cows,  animals  that  have  never  enjoyed  the  con- 
sideration accorded  to  the  horse?  Simply  because  the  cows  pro- 
duce a  marketable  product,  for  which  there  is  an  unlimited 
demand ;  a  product  that  the  public,  with  ever-increasing  insistence, 
demand  shall  be  clean ;  a  product  that  cannot  be  secured,  in 
cleanly  and  healthful  condition,  from  stock  that  is  encrusted  with 
filth.  In  connection  with  the  question  of  tuberculosis  in  cattle, 
it  is  claimed  that  the  milk  from  an  infected  cow  may  be  innocuous 
if  the  udder  is  not  diseased.  However  this  claim  may  be  settled, 
it  is  an  undeniable  fact,  that  a  tuberculous  cow  with  a  perfectly 
healthy  udder  may  pass  innumerable  bacilli  of  tuberculosis  in  the 
fasces.  The  entrance  of  an  infinitesimal  portion  of  such  material 
into  the  milk,  by  being  rubbed  ofif  the  udder  or  the  neighboring 
parts  during  the  milking,  is  sufficient  to  contaminate  the  milk  of 
the  whole  herd  and  render  it  unfit  for  use.  This  has  been  repeat- 
edly demonstrated  in  the  laboratories,  by  the  injection  of  the 
infected  milk  into  the  lower  animals  and  the  production  thereby  of 
tuberculosis. 

These  suggestions  as  to  the  housing  and  care  of  dairy  cattle, 
if  carefully  considered,  will  be  found  to  be  wholly  reasonable. 
They  are  observed  on  the  best  farms  to-day  and  should  be  uni- 
versally observed,  with  such  modifications  as  may  be  demanded 
by  special  conditions. 


FOR   THE    INVESTIGATION    OF   TUBERCULOSIS.  73 


MILKERS  AND  MILKING. 


The  importance  of  securing  clean  milk,  not  only  as  a  protec- 
tion of  the  public  health,  but  to  ensure  a  remunerative  price  to 
the  producer,  makes  careful  attention  to  every  detail  in  its  pro- 
duction and  distribution  a  matter  of  the  deepest  personal  interest 
to  every  dairyman.  The  cows  may  be  housed  in  the  best  manner 
possible  and  the  whole  product  of  the  dairy  ruined  by  a  careless 
or  unclean  workman.  This  phase  of  the  subject  introduces  per- 
haps the  most  difficult  problem  that  the  dairyman  has  to  solve. 
Farm  "help"  must  be  entrusted  with  much  of  the  work  about 
a  stable  of  any  size,  and  farm  "help,"  as  it  is  to-day,  is  often 
exceedingly  indifferent.  It  is  easy  to  advocate  the  employment 
of  intelligent  and  sympathetic  workers  upon  our  dairy  farms,  men 
who  in  the  absence  of  the  owner  will  consider  his  interests  as 
their  own ;  but  such  "help"  is  not  easily  found,  and  in  some 
sections  of  the  country  cannot  be  procured  at  any  cost. 

It  is  not  an  idle  refinement  to  insist  that  the  person  doing  the 
milking  shall  be  clean,  that  he  shall  be  dressed  in  a  clean  milking 
garment  and  have  absolutely  clean  hands,  thoroughly  washed  and 
dried  before  milking.  It  is  essential  that  all  utensils  used  shall 
have  been  properly  cleansed  and  sterilized.  The  large  dairies  can 
usually  secure  the  services  of  a  qualified  superintendent,  who 
attends  solely  to  the  dairy  work,  but  the  smaller  farmers  cannot 
afford  the  services  of  an  expert  and  must  rely  upon  their  own 
executive  ability.  The  amount  of  extra  time  called  for,  in  follow- 
ing out  these  suggestions  for  the  proper  production  of  milk,  is  in 
fact  much  less  than  at  first  appears.  The  stables  once  properly 
ordered,  do  not  require  much  more  attention  than  before.  The 
cattle,  if  treated  systematically,  can  be  cleaned  and  milked  within 
a  reasonable  time,  and  it  should  be  remembered  that  all  this 
work  is  to  secure,  in  best  marketable  condition,  the  most  import- 
ant article  of  food  in  the  world. 

To  some  who  are  constitutionally  averse  to  all  new  ideas,  these 
regulations  of  the  dairy  are  irksome,  and  there  is  not  infrequently 


74  REPORT    OF    THE    COMMISSION 

a  disposition  shown  to  cover'  personal  indolence  with  the  cloak  of 
ridicule.  The  small  farmer  is  liable  to  discouragement  and,  in  a 
spirit  of  discontent,  to  disregard  all  sanitary  precautions.  There 
is,  furthermore,  an  unfortunate  tendency,  widespread  in  its  influ- 
ence, to  treat  with  the  most  tmreasoning  hostility  the  efforts  of  our 
boards  of  health  to  rectify  the  evil  conditions  that  do  so  much  to 
bring  disease  and  death,  not  to  the  city  people  alone,  but  to  the 
whole  community.  To  those  who  believe  that  all  the  efforts 
made  to  secure  pure  milk  are  in  the  interest  of  a  privileged  class 
and  are  of  no  interest  to  themselves,  it  is  proper  to  reply :  You 
may  leave  out  of  consideration  all  humanitarian  considerations, 
you  may  be  utterly  indifferent  to  the  quality  of  the  milk  you  sell, 
but  you  are  blind  to  your  own  interests  if  you  do  not  care  for  your 
cows.  The  great  question  for  all  farmers  to-day  is,  What  is  to 
be  done  to  arrest  the  progress  of  this  tuberculosis,  that  is  already 
threatening  the  value  of  our  stock?  Whatever  may  be  done,  the 
first  duty  is  to  give  them  pure  air,  clean  stalls  and  fair  treatment. 

The  reforms  advocated  cannot  be  brought  to  fruition  without 
the  assistance  of  the  State.  Much  can  be  done  by  a  well-organ- 
ized effort,  to  interest  the  public  as  to  proper  methods  and  to 
arouse  them  to  a  due  appreciation  of  the  danger  to  their  own 
interests  from  bovine  tuberculosis.  But  there  is  a  large  element 
that  will  not  be  influenced  by  any  consideration,  whose  carelessness 
imperils  the  interests  of  their  neighbors.  These  misguided  people 
can  only  be  reached  by  state  inspection,  and  in  case  of  obduracy 
upon  their  part,  by  having  to  suffer  a  proper  penalty.  The  present 
statute,  empowering  the  dairy  commissioner  to  inspect  all  milk- 
producing  farms,  is  in  a  measure  satisfactory,  but  it  does  not  go 
far  enough. 

It  is  as  follows  : 

"The  Dairy  Commissioner  shall  make  an  investigation 
and  examination  of  the  premises  of  any  farm  or  dairy, 
or  of  any  place  where  cattle,  dairy  stock  or  other 
domestic  animals  are  kept  within  this  state  where 
any  unsanitary  condition  affecting  the  products  of 
such  farm  or  dairy  exists  or  is  reported  or  sus- 
pected to  exist.  When  any  such  condition  shall  be  found 
by  said  Dairy  Com.missioner  he  shall  notify  the  owner 
or  occupant  of  the  premises  upon  which  such  conditions 


FOR   THE    INVESTIGATION    OF   TUBERCULOSIS.  75 

exist  to  remove  or  abate  the  same,  at  the  expense  of  such 
owner  or  occupant,  within  such  time  as  the  Dairy  Com- 
missioner shall  direct;  and  if  such  owner  or  occupant 
shall  neglect  to  remove  or  abate  such  condition  within 
said  time  prescribed  he  shall  be  fined  not  more  than  25 
dollars  and  shall  pay  such  expense  and  costs  as  shall 
be  incurred  in  such  removal  or  abatement.  The  Dairy 
Commissioner  is  authorized  and  empowered  to  employ 
such  assistants  as  shall  be  necessary  to  enforce  the  pro- 
visions of  this  act,  and  said  Commissioner  and  assistants 
shall  have  free  access  at  all  reasonable  hours  to  all  such 
premises  and  places  for  the  purpose  of  making  the 
investigation  and  examination  provided  by  this  act. 
Every  person  refusing  said  access  shall  be  fined  not  more 
than  seven  dollars  or  imprisoned  not  more  than  30  days 
or  both." 

This  statute  would  seem  to  meet,  in  a  reasonable  and  satis- 
factory manner,  the  requirements  for  a  thorough  inspection  of 
all  dairy  farms.  As  a  fact,  the  inspection  has  been  already  in 
force  and  some  effort  made  to  improve  insanitary  conditions,  as 
they  have  been  encountered.  Such  a  statute  is,  however,  of  no 
value,  if  it  is  not  supported  by  an  appropriation  that  is  sufficient  to 
allow  a  proper  execution  of  its  requirements.  The  State  of  Con- 
necticut has  a  great  duty  to  perform  in  this  matter.  It  is  a  wealthy 
and  a  generous  state,  and  it  cannot  afford  to  appear  to  favor  an 
important  reformatory  measure  and  then  render  it  practically 
inoperative  by  making  an  appropriation  wholly  inadequate.  No 
man,  who  is  conducting  his  farm  in  a  suitable  manner,  has  cause 
for  objection  to  repeated  inspection.  The  leading  dairies  of  the 
State  welcome  every  form  of  inspection.  It  is  only  the  careless 
and  indifferent  and  criminal  who  seek  to  avoid  the  light.  These  are 
a  menace  to  the  welfare  of  all  their  more  thrifty  and  conscientious 
neighbors  and  money  cannot  be  better  spent  than  in  bringing  them 
to  a  proper  recognition  of  their  duty  as  citizens. 

There  is  another  point  in  which  this  statute  would  seem  to  be 
unsatisfactory.  The  commissioner,  where  he  discovers  a  serious 
condition,  has  not  sufficient  power  to  bring  about  an  immediate 
abatement,  if  there  is  a  refusal  to  comply  with  his  directions. 
There    should    be    some    provision    by    which    the    dairy    com- 


76  REPORT   OF   THE    COMMISSION 

missioner  could  bring  offenders  to  immediate  compliance  with  the 
law.    In  Section  lo,  Chapter  143,  we  read: 

"The  warden  and  burgesses  of  a  borough,  or  the 
Alayor  with  the  approval  of  the  Common  Council  of 
a  city,  may  appoint  a  competent  person  as  milk  inspector 
who  may  personally,  or  by  some  competent  person 
appointed  by  him,  inspect  all  milk  or  cream  sold  or 
offered  for  sale  in  such  borough  or  city;  may  inspect 
all  animals  producing  such  milk,  the  buildings  or  places 
where  such  animals  are  kept,  the  dairy  and  other  places 
where  such  milk  or  cream  is  kept,  handled,  sold  or  pro- 
duced, whether  the  same  be  within  the  limits  of  such 
borough  or  cit}',  or  not :  and  said  burgesses  or  common 
council  may  prohibit  the  sale  of  such  milk  or  cream 
within  the  limits  of  such  borough  or  city,  except  by  such 
persons  as  shall  register  their  names,  residences  and 
numbers  in  a  book  kept  for  the  purpose  at  the  office  of 
the  clerk  of  such  borough  or  city.  Such  inspector  or 
assistant  shall  have  the  right  to  take  samples  of  milk 
or  cream  from  any  producer  or  vendor  upon  tender  of 
the  market  price  thereof,  but  he  shall,  if  such  producer 
or  vendor  so  requests,  seal  and  make  a  duplicate  sample 
of  such  milk  or  cream  and  leave  the  same  with  such 
producer  or  vendor.'' 

This  statute  certainly  gives  broad  powers  to  the  communities 
in  which  milk  is  sold,  to  protect  themselves  against  an  impure 
article.  It  would  seem  to  be  a  perfectly  reasonable  and  practic- 
able measure,  to  insist  by  an  amendment  to  the  present  statute, 
that  every  citizen  of  the  State  who  produces  milk  for  sale  shall 
be  required  to  procure  a  license  to  conduct  such  business  from 
the  State  Board  of  Health;  such  license  to  be  issued  free  of  cost 
to  the  producer,  and  without  previous  examination  by  the  State 
Board  of  Health  into  the  conditions  under  which  such  milk  is  pro- 
duced; the  names  and  numbers  of  all  persons  so  licensed  to  be 
immediately  forwarded  by  the  State  Board  of  Health  to  the  dairy 
commissioner's  office.  The  present  statute,  already  quoted, 
empowers  the  dairy  commissioner  to  inspect  as  fully  as  may  be 
deemed  necessary.  His  efficiency  would  seem  to  be  greatly  aug- 
mented, if  the  present  statute  could  be  amended  so  as  to  read: 


FOR   THE    INVESTIGATION    OF   TUBERCULOSIS.  77 

"If  such  owner  or  occupant  shall  neglect  to  remove  or  abate  such 
condition  within  the  time  prescribed,  his  neglect  shall  be  reported 
to  the  secretary  of  the  State  Board  of  Health,  who  shall  cause 
his  license  to  sell  milk  throughout  the  State  of  Connecticut  to  be 
suspended,  until  the  dairy  commissioner  shall  report  to  said  board 
that  the  producer  has  complied  with  his  directions."  The  power 
that  would  thus  be  given  to  the  dairy  commissioner,  through  the 
State  Board  of  Health,  to  stop  the  business  of  an  objectionable 
dealer,  would  enable  him  to  exert  an  immediate  influence  of  great 
potency.  It  is  to  be  remembered,  that  such  power  to  stop  the 
sale  of  milk  already  exists  in  all  cities  and  boroughs,  and  it 
should  be  further  understood  that  no  milk  can  be  sold  in  our 
cities  except  under  a  license  from  the  local  board  of  health.  The 
suggestions  as  to  the  alteration  in  the  present  statute,  introducing 
the  State  Board  of  Health  to  work  in  support  of  the  dairy  com- 
missioner, is  simply  an  effort  to  broaden  the  present  plan  in  such 
manner  as  to  embrace  the  whole  dairy  business  of  the  State. 

The  transportation  and  distribution  of  dairy  products  ^  has 
been  the  subject  of  earnest  study  for  years.  The  product  of  the 
best  farms  not  infrequently  is  passed  through  so  many  hands  and 
carried  in  so  many  vehicles  as  to  seriously  impair  its  value.  The 
regulation  of  this  side  of  the  business  is  largely  under  control 
of  local  health  boards,  and  for  the  present  at  least,  it  would  seem 
that  the  State  cannot  attempt  to  secure  the  direction  of  such  a 
complicated  undertaking.  If  the  State  will  insist  upon  the  proper 
care  of  cattle  and  thus  ensure  the  production  of  pure  milk,  it  will 
have  done  its  full  duty  and  will  have  taken,  at  the  same  time,  the 
most  important  step  toward  the  arrest  of  bovine  tuberculosis. 

Within  recent  years,  it  has  been  the  custom  to  pasteurize  milk ; 
that  is,  to  subject  the  milk  to  the  temperature  of  140°  Fahrenheit 
for  twenty  minutes  and  then  cool  rapidly,  thus  destroying  the 
pathogenic  bacteria  that  may  infect  it.  The  question  has  been 
asked,  why  this  pasteurization  may  not  be  universally  practiced 
in  our  cities  and  all  the  injurious  qualities  of  the  milk  be  sum- 
marily disposed  of  by  this  process.  While  such  procedure  would 
undoubtedly  be  hailed  joyously,  by  dairymen  who  have  no  desire 
to  conform  to  the  strict  regulations  demanded  of  them  by  the 
seekers  for  pure  milk,  it  would  be  most  disastrous  to  the  interest 
of  the  public.  It  would  simply  put  an  end  to  efforts  to  purify  the 
raw  product  and  would  be  nothing  less  than  encouragement  to 


78  REPORT   OF   THE    COMMISSION 

the  prevalent  carelessness.  As  matters  are  to-day,  the  milk  sold 
in  all  cities  in  the  country  is  very  unsatisfactory.  The  product  of 
the  dairies  that  aim  to  furnish  a  pure  article  is  a  mere  drop  in  the 
bucket.  No  one  can  hope  for  a  very  radical  change  for  many 
years.  The  State  has  its  duty  clearly  laid  out,  to  suppress  the 
evils  that  exist  as  rapidly  as  possible,  and  the  effort  must  ever 
be  to  secure,  at  some  time  in  the  future,  a  milk  service  that  will 
be  safe  and  profitable.  Until  that  day  comes,  pasteurization  must 
be  resorted  to  in  the  larger  towns  and  cities.  This  is  best  done 
in  the  home  where  there  is  sufficient  intelligence,  but  in  the  main 
it  will  have  to  be  done  by  central  pasteurizing  plants,  which  may 
be  supported  by  private  enterprise,  or  by  some  municipal  board. 
The  greatest  danger  in  the  process  comes  from  the  assurance  of 
perfect  safety  that  it  gives  to  the  consumer.  Heated  milk  is  not 
necessarily  safe  milk.  It  calls  for  as  careful  and  intelligent  after- 
treatment  as  raw  milk.  When  the  progress  of  decomposition  of 
impure  milk  has  been  simply  arrested  by  heat,  no  one  knows  what 
the  condition  of  the  milk  is,  but  it  certainly  is  not  fit  for  use.  Any 
attempt  to  pasteurize  at  the  dairy  and  dispense  to  the  public  would 
be,  if  scientifically  done,  quite  as  expensive  as  the  simple  methods 
that  have  been  suggested  to  secure  pure  milk.  Much  objection  has 
been  raised  against  the  proposition  to  pasteurize  milk,  upon  the 
ground  that  it  will  seriously  hamper  the  efforts  that  are  being 
made  to  secure  a  clean,  pure  article.  The  pasteurization  is  recom- 
mended simply  because,  in  the  present  condition  of  the  dairy 
industry  in  our  State,  much  of  the  milk  is  dangerous  and  unfit 
for  infant  feeding.  It  will  be  a  long  time  before  the  milk  sold 
in  our  cities  will  be  of  the  proper  standard.  Certified  milk,  and 
milk  known  to  come  from  properly  conducted  dairies  and  known 
to  be  free  from  tuberculosis,  need  not  be  pasteurized.  Any  plant 
established  by  a  city  for  the  purpose  of  distributing  pasteurized 
milk  to  its  citizens,  should  be  under  competent  scientific  super- 
vision. The  milk  received  at  these  institutions  should  be  subjected 
to  a  close  examination,  and  all  milk  found  unfit  for  use  should  be 
destroyed.  The  idea  that  any  milk,  no  matter  how  old  or  how 
foul,  can  be  sold  to  the  pasteurizer  and  converted  into  a  suitable 
article  of  food,  is  preposterous. 


SLEEPING    SHACK.      GIFT    OF    MR.    S.    W.    HART. 


A  TUCKER  TENT.      GIFT  OF   MR.   MAX  ADLER. 
Gaylord  Farm  Sanatorium. 


FOR   THE    INVESTIGATION    OF   TUBERCULOSIS.  79 


THE  CARE  OF  TUBERCULOUS  CATTLE. 


The  care  of  tuberculous  cattle  has  become  a  question  of  unusual 
interest  the  world  over.  The  discovery  of  the  tubercle  bacillus 
and  the  subsequent  discovery  of  the  bovine  tuberculosis,  with  a 
similar  but  distinct  bacillus  as  its  exciting  cause,  has  led  to  much 
investigation,  to  determine  the  possibility  of  the  transmission  of 
tuberculosis  from  animal  to  man  and  from  man  to  the  lower  ani- 
mals. The  widespread  interest  that  has  been  developed  in  the 
efforts  to  suppress  tuberculosis  has  led  to  much  extravagance  of 
statement.  Many  questions  of  vast  importance  to  the  dairy  interest 
are  still  unanswered  and  are  in  some  instances  the  source  of  bitter 
controversy.  The  assumption  that  the  milk  from  tuberculous  cows 
was  the  cause  of  the  major  part  of  human  tuberculosis,  has  led  to 
demands  for  radical  measures  that  imperil  the  dairy  industry,  to 
say  nothing  of  the  possible  milk  famine  that  the  wholesale 
slaughter  of  apparently  healthy  cattle  might  cause.  It  is  assumed 
that  all  right-minded  producers  desire  to  sell  a  healthful  article. 
There  is  no  reason  to  suppose  that  the  Connecticut  farmer  is  any 
more  indifferent  to  the  quality  of  milk  he  sells  than  are  his  cus- 
tomers. The  unprincipled  or  ignorant  producer,  who  feels  no 
responsibility  in  a  matter  of  such  importance,  is  a  negligible  factor 
in  all  legislative  proceedings.  At  the  same  time,  it  is  not  unnatural 
for  a  farmer  owning  a  valuable  herd  of  cows,  which  may  possibly 
represent  a  considerable  portion  of  all  his  holdings,  to  object  to 
their  being  killed  by  the  State  by  reason  of  their  reacting  to  tuber- 
culin. There  can  be  no  question,  in  the  light  of  recent  investiga- 
tion, as  to  the  possibility  of  the  occasional  transmission  of  the 
bovine  bacillus  to  the  human  being,  as  the  actual  presence  of  the 
bovine  bacillus  in  the  human  being  has  been  demonstrated.  This 
most  important  question  has  been  under  investigation  by  a  royal 
commission  in  Great  Britain,  and  their  reports  have  been  char- 
acterized by  conservatism  and  an  unwillingness  to  publish  definite 
conclusions.  Their  work  is  still  incomplete,  but  in  their  second 
interim  report,  as  quoted  by  Dr.  Bulstrode,  they  make  definite 


8o  REPORT   OF   THE    COMMISSION 

statements  bearing  upon  this  question  of  transmission  through 
milk  that  must  be  accepted  as  authoritative.  They  say :  "There 
can  be  no  doubt  but  that  in  a  certain  number  of  cases  the  tuber- 
culosis occurring  in  the  human  subject,  especially  in  children,  is 
the  distinct  result  of  the  introduction  into  the  human  body  of  the 
bacillus  of  bovine  tuberculosis.  And  there  can  also  be  no  doubt 
that  in  the  majority  at  least  of  these  cases  the  bacillus  is  introduced 
through  cow's  milk.  Cow's  milk  containing  bovine  tubercle 
bacilli  is  clearly  a  cause  of  tuberculosis  and  fatal  tuberculosis 
to  man."  "A  very  considerable  amount  of  disease  and  loss  of 
life,  especially  among  the  young,  must  be  attributed  to  the  con- 
sumption of  cow's  milk  containing  tubercle  bacilli." 

So  eminent  an  authority  as  Theobald  Smith  says :  "We  have 
learned  that  in  a  selected  number  of  cases  of  alimentary  tuber- 
culosis the  bovine  bacillus  has  been  found.  This  is  all  we  know 
and  all  the  rest  is  uncertain  and  speculative."  If  bovine  tubercu- 
losis is  a  frequent  cause  of  human  tuberculosis,  in  fact,  as  some 
claim,  the  chief  cause,  then  through  its  transmission  the  bovine 
must  change  into  the  human  type.  This  is  equivalent  to  the  asser- 
tion, that  the  differences  in  characteristics  noticeable  in  the  two 
types  are  modifications  caused  by  the  host  in  which  the  bacillus 
is  developed.  Dr.  Theobald  Smith  again  says  :  "If  the  bovine  and 
human  cultures  are  indiscriminately  transmissible  to  either  species, 
why  should  two  types  have  arisen  ?"  "That  the  bovine  type  should 
be  converted  into  the  human  type  has  no  analogy  in  the  domain  of 
bacteriology."  The  nature  of  this  report  does  not  admit  of  a 
detailed  discussion  of  this  most  important  question,  but  the 
question  as  to  the  transmissibility  of  bovine  tuberculosis  to 
the  human  being  is  of  the  highest  importance,  and  must 
be  referred  to,  because  of  the  radical  announcement  of  Koch  in 
1891,  that  there  was  no  serious  danger  to  man  from  the  use  of 
milk  that  contained  the  bovine  bacillus.  The  extent  of  the  investi- 
gation that  was  developed  the  world  over,  through  this  announce- 
ment, is  truly  amazing,  and  it  must  be  admitted  that 
the  result  has  been  to  disprove  the  accuracy  of  the  statement  of 
Koch.  It  cannot  be  denied,  that  human  tuberculosis  may  be 
developed  through  the  ingestion  of  infected  milk.  The  discussion 
of  this  question  of  the  transmissibility  of  bovine  tuberculosis 
occupied  much  of  the  time  of  the  late  International  Congress  on 
Tuberculosis.     The  daily  press  has  reported  the  matter  so  fully 


FOR    THE    INVESTIGATION    OF    TUBERCULOSIS.  8 1 

that  the  difference  of  opinion  between  Dr.  Koch  on  one  side  and, 
it  may  be  said,  almost  the  entire  body  of  those  who  can  justly 
be  called  experts  on  the  other,  is  well  understood  by  the  public. 
The  deliberations  of  this  great  congress  have  placed  beyond  ques- 
tion the  possible  transmission  of  bovine  tuberculosis,  especially  in 
infancy  and  childhood.  There  is  good  reason  for  believing,  that 
all  intestinal  and  bone  tuberculosis  in  childhood  may  be  of  bovine 
origin.  It  is  apparent  that  the  frequency  of  infection  of  the 
human  being  through  milk  is  not  known.  The  fact  that  it  is 
surely  a  possible  source  of  infection  makes  the  effort  to  eradicate 
tuberculosis  from  the  herds  of  the  State  an  imperative  duty.  All 
eft'orts  in  this  direction  work  not  only  for  the  good  of  the  con- 
sumer of  milk,  but  from  the  most  selfish  standpoint  conceivable 
are  of  paramount  importance  to  the  owners  of  the  stock.  Men 
who  scoff  at  remedial  measures  and  claim,  through  some  extra- 
ordinary insight,  to  know  that  the  discoveries  of  modern  science 
are  unreliable,  are  blind  to  their  own  interests. 

It  is  unquestionably  true,  that  no  effective  measures  can  be  taken 
toward  the  cure  of  a  disease  without  an  accurate  diagnosis.  The 
first  question  for  every  dairyman  to  answer  is.  Have  any  of  my 
herd  tuberculosis?  If  he  is  fortunate  enough  to  be  able  to  say 
truthfully  that  they  are  free  from  it,  then  he  has  the  compara- 
tively simple  task  of  keeping  them  free  from  infection.  But 
how  can  a  man  say  with  certainty  that  he  has  no  tuberculosis  in 
his  herd?  Many  will  answer  by  physical  examination.  So  bitter 
has  been  the  experience  of  some  farmers  that  it  is  difficult  to 
discuss  this  question  with  them  at  all.  It  is,  however,  a  fact, 
that  tuberculosis  may  exist  in  a  cow  that  presents  every  appear- 
ance of  perfect  health.  It  is  further  true,  that  in  many  of  these 
cases  the  disease  is  not  discoverable  by  physical  diagnosis  alone. 
Is  it  of  importance,  if  this  be  true,  that  any  other  means  for  secur- 
ing an  accurate  diagnosis  should  be  resorted  to?  To  the  owner 
of  the  cow  and  for  the  future  welfare  of  his  whole  business,  it 
is  highly  important.  One  such  apparently  sound  animal  may 
infect  a  whole  herd,  before  the  disease  has  advanced  to  the  point 
where  it  can  be  demonstrated  by  physical  tests  alone.  It  is  further 
to  be  understood,  that  a  very  large  number  of  those  who  consider 
themselves  competent  to  make  a  thorough  phj'sical  examination, 
are  utterly  unqualified  for  the  work. 


REPORT    OF    THE    COMMISSION 


THE  TUBERCULIN  TEST. 


So  much  has  been  written  of  a  popular  character  upon  the 
tubercuhn  test,  and  such  prejudiced  and  unreliable  statements 
have  been  widely  published,  that  it  is  not  easy  to  secure  a  fair 
hearing  upon  the  subject.  In  some  of  the  recent  newspaper 
comments  upon  tuberculin,  it  has  been  stated,  that  no  tuberculin 
should  be  injected  into  animals,  because  it  had  been  found  so 
highly  destructive  in  its  use  upon  human  beings  as  to  be  discarded 
wholly  by  all  reputable  physicians,  that  no  reputable  physician 
would  dare  use  it  to-day.  A  full  history  of  tuberculin  is  not  called 
for  in  this  report,  but  it  is  important  some  facts  as  to  its  use 
should  be  made  clear.  Immediately  after  its  first  introduction 
by  Koch  it  was  not  fully  understood,  the  doses  used  in  the  treat- 
ment of  many  cases  were  too  large,  and  in  some  cases  were  fol- 
lowed by  serious  consequences.  This  resulted  in  a  practical 
abandonment  of  the  use  of  tuberculin  for  several  years.  Its  use 
was  not  abandoned  altogether.  A  more  careful  study  as  to  the 
proper  use  removed  all  danger.  It  has  been  used  more  frequently 
and  with  better  results  from  year  to  year,  and  so  far  from  a 
reputable  physician  not  daring  to  use  it,  there  is  probably  not 
a  specialist  of  any  importance  in  the  world  to-day  who  is  not 
using  tuberculin,  or  some  of  its  modified  forms,  in  the  treatment 
of  some  of  his  consLimptive  patients.  A  properly  prepared  tuber- 
culin, intelligently  administered,  is  harmless. 

This  statement  answers  the  charge  that  it  often  produces  tuber- 
culosis. Such  an  occurrence  is  an  impossibility.  As  well  claim 
that  sprinkling  a  field  with  cider  might  produce  an  apple  orchard. 
If  a  cow  develops  tuberculosis  a  year  after  an  injection  of  tuber- 
culin, that  fact  certainly  does  not  prove  the  charge  that  the  tuber- 
culin was  responsible.  The  claim  that  the  use  of  tuberculin  might 
arouse  into  activity  a  latent  tuberculosis,  is  not  so  unreasonable. 
Any  animal  with  latent  tuberculosis  is  liable  to  have  an  active 
process  at  any  tim.e,  and  it  is  not  proven  that  the  resultant  fever 


FOR   THE    INVESTIGATION    OF   TUBERCULOSIS.  83 

from  tuberculin  reaction,  and  the  accompanying  activity  in  the 
lesion  itself,  may  not  continue  and  produce  the  generalized  disease. 
If  so,  it  is  rare,  and  such  an  occurrence,  it  must  be  borne  in  mind, 
is  only  possible  where  the  disease  already  exists. 

As  to  the  influence  upon  the  health  of  a  herd  free  from  tuber- 
culosis, the  tuberculin  test  is  harmless.  The  many  claims  pub- 
lished by  dairymen,  that  where  there  was  no  reactioli  from  the 
test  the  herds  have  subsequently  deteriorated,  are  not  to  be 
accepted  and  cannot  be  established.  Most  of  such  unwarranted 
statements  are  the  result  of  animosity,  aroused  by  the  enforced 
test  and  the  wholesale  slaughter  that  has  been  going  on  in  some 
states,  for  which  there  can  be  no  justification. 

It  is  for  the  interest  of  all  dairymen  to  have  their  herds  tuber- 
culin tested  at  suitable  intervals  and  to  keep  them  free  from 
tuberculosis.  This  testing  should  always  be  done  by  an  experi- 
enced man  and  care  should  be  observed  to  secure  reliable  tuber- 
culin. Testing  seems  simple,  and  yet  it  calls  for  excellent 
judgment.  The  question  of  the  temperature  of  cows  is  important. 
In  perfect  health  cows  show  a  temperature  fluctuation  that  may 
amount  to  two  or  three  degrees,  which  may  be  erroneously 
attributed  to  tuberculosis.  The  whole  question  involves  so  many 
points  for  discussion  that  a  more  detailed  consideration  is  not 
possible  in  this  report.  Whenever  the  tuberculin  test  is  asked  for, 
it  is  to  the  State's  interest  to  empower  the  cattle  commissioner  to 
employ  an  experienced  operator  and  to  give  the  test  free  of  cost. 
Whenever  a  herd  is  known  to  the  cattle  commissioner  to  be  free 
from  tuberculosis,  he  should  be  authorized  to  issue  to  the  owner 
a  stamp  indicating  the  fact,  which  may  be  placed  upon  all  recepta- 
cles containing  the  milk,  with  the  understanding  that  no  new  cattle 
are  introduced  into  the  herd,  until  they  have  been  tested  and 
accepted  by  the  cattle  commissioner.  This  testing  of  dairy  cattle 
is  destined  to  continue  and  those  who  accept  it  will  receive  a 
higher  price  for  their  dairy  products.  People  will  ultimately 
demand  stamped  milk.  On  small  farms,  where  the  owner  does  not 
feel  called  upon  to  test  his  cattle,  the  inspection  of  the  dairy  com- 
missioner is  the  only  safeguard. 

Without  the  tuberculin  test,  it  has  been  shown  that  the  disease 
cannot  be  detected  in  many  cows  that  are  unquestionably  seriously 
infected.    Where  tuberculosis  is  capable  of  detection  upon  a  phys- 


84  REPORT   OF   THE    COMMISSION 

ical  examination,  the  animal  should  be  slaughtered.  It  is  possible 
that  from  some  cows  clearly  infected  with  tuberculosis,  a  calf 
may  be  secured  before  the  mother  is  slaughtered,  and  if  the 
mother  is  isolated  and  due  precautions  are  taken  against  infecting 
other  cattle,  the  time  for  killing  such  an  animal  shall  be  determined 
by  the  cattle  commissioner.  To  sell  milk  from  such  a  cow  should 
be  a  serious  offense  before  the  law.  The  wholesale  slaughter  of 
all  cattle,  even  when  the  disease  has  been  detected  by  the  tuber- 
culin test,  as  has  been  done  in  some  states,  is  not  to  be  tolerated. 

The  chief  effort  for  the  State  is  to  encourage  voluntary  meas- 
ures to  purify  the  herds  of  the  State,  by  the  most  advanced  scien- 
tific methods ;  to  create  as  widespread  a  sentiment  among  the 
farmers  of  the  State  as  is  possible  in  favor  of  the  better  housing 
of  cattle  and  handling  of  the  milk,  without  which  all  efforts  are 
in  vain,  and  finally  to  educate  the  dairymen  in  the  Bang  system 
for  the  eradicdltion  of  tuberculosis  by  isolation  of  the  infected 
cattle — a  system  that  has  shown  almost  incredible  results  in  the 
betterment  of  cattle  conditions  in  Denmark,  reducing  the  disease 
in  the  cattle  of' Denmark  from  thirty-five  and  five-tenths  per  cent, 
to  four  per  cent.  In  this  report  the  Bang  system  can  only  be 
referred  to,  in  the  hope  that  the  public  may  be  led  to  full  exposi- 
tion of  the  system. 

Upon  one  point  in  the  treatment  of  tuberculosis  in  cattle,  all  the 
citizens  of  the  State  should  be  of  one  accord.  No  cattle  should 
be  allowed  to  be  brought  into,  the  State  of  Connecticut  that  have 
not  been  tuberculin  tested.  Such  a  law  as  to  the  importation  of 
cattle  exists  in  all  the  neighboring  states.  In  Connecticut  we  have 
no  law  bearing  upon  the  question.  Connecticut  is  the  dumping- 
ground  of  all  our  neighbors  for  tuberculous  cattle.  There  are 
in  our  State  some  so  foolish  as  to  suppose,  that  because  they  have 
secured  a  cow  below  her  apparent  value,  they  can  close  their  eyes 
to  the  fact  that  tuberculin  has  proved  her  to  be  diseased.  These 
men  are  destined  to  ruin  their  herds,  if  they  are  not  already  ruined. 
More  than  that,  they  are  imperiling  the  value  of  their  neighbors' 
property.  Public  sentiment  should  uphold  the  State  in  measures 
of  the  utmost  stringency  to  discover  these  miscreants.  In  the 
annual  report  of  the  Board  of  Agriculture  of  Massachusetts  for 
1907,  the  following  is  enumerated  as  among  the  duties  of  the 
Cattle  Bureau : 


FOR   THE    INVESTIGATION    OF   TUBERCULOSIS.  85 

"Second.  Keeping  up  the  quarantine  work,  to  prevent  tuber- 
culous animals  from  being  introduced  into  the  dairy  and  breeding 
herds  of  this  Commonwealth  from  adjoining  states.  This  includes 
the  testing  of  all  neat  cattle  brought  into  the  State  except  beeves 
for  immediate  slaughter,  or  calves  under  six  months  old;  cattle 
returning  from  out-of-State  pastures,  or  coming  in  for  exhibition 
purposes  or  returning  home  from  cattle  shows  in  adjoining  states, 
are  also  exempt  from  the  test.  All  the  cattle  upon  which  a  test 
is  required  shipped  to  the  stock  yards  at  Brighton,  Watertown  and 
Somerville,  are  tested  by  the  agent  of  the  Cattle  Bureau  in  charge 
of  these  quarantine  stations.  Cattle  upon  which  a  test  is  required 
brought  to  points  outside  of  these  stock  yards,  which  are  con- 
sidered to  be  quarantine  stations,  must  be  accompanied  by  satis- 
factory certificates  of  tuberculin  test  made  by  veterinarians  in  the 
states  from  which  they  come,  approved  by  the  Chief  of  the  Cattle 
Bureau ;  or  they  are  held  upon  arrival  at  destination  and  tested 
by  an  agent  of  the  Cattle  Bureau,  free  of  expense  to  citizens  of 
Massachusetts  and  at  cost  to  citizens  of  other  states,  but  at  their 
risk.  Cattle  passing  a  satisfactory  test  are  released  from  quaran- 
tine." Such  restrictions  upon  the  importation  of  cattle  are  in  the 
interest  of  every  honest  farmer  in  the  State. 

Certainly  no  argument  can  be  called  for  to  sustain  the  claim  that 
the  importation  of  tuberculous  cattle  into  our  State  should  be 
immediately  stopped.  Those  who  are  interested  in  defeating 
measures  directed  to  the  arrest  of  such  an  evil,  are  inimical  to 
the  interest  of  every  honest  farmer  in  the  State.  They  should 
be  made  to  feel  that  weight  of  public  opinion  that  is  the  most 
powerful  agent  in  securing  all  reforms. 

The  effort  has  been  made  to  show,  that  in  the  dairy  question, 
as  related  to  the  tuberculosis  question,  it  is  of  the  first  importance 
for  the  State  to  secure  adequate  inspection  of  the  care  shown 
to  cattle  throughout  the  State ;  to  secure,  thereby,  sanitary  treat- 
ment for  cattle,  without  which  all  effort  to  eliminate  tuberculosis 
in  the  herds  will  be  in  vain. 

Further,  that  the  State  should  do  all  that  may  be  proper  to 
encourage  the  scientific  test  of  all  herds  in  the  State  and  to 
educate  the  owners  of  cattle  in  the  system  of  segregation  that 
may  enable  the  owners  ultimately  to  clear  their  farms  of  a  most 
destructive  disease,  and  that,  too,  without  serious  pecuniary  loss. 


S6  REPORT  OF  THE  COMMISSION,  ETC. 

A  further  effort  has  been  made  to  emphasize  the  fact,  that  aside 
from  all  consideration  of  the  question  of  human  tuberculosis,  the 
State  has  reason  to  act,  and  act  promptly,  for  the  eradication  of 
bovine  tuberculosis,  a  disease  that  is  tending  to  the  ultimate 
destruction  of  the  dairy  business. 

John  P.  C.  Foster,  M.D.,  Chairman,  New  Haven. 

Stephen  J.  Maher,  M.D.,  New  Haven. 

Omer  La  Rue,  M.D.,  Putnam. 

Horace  B.  Cheney,  South  Manchester. 

Arthur  R.  Kimball,  Waterbury. 

John  F.  Gunshanan,  Hartford. 

Rev.  James  B.  Nihill,  Bridgeport. 

Albert  P.  Dossin,  Meriden. 

William  J.  Brennan,  New  London. 

Charles  E.  Julin,  Secretary. 


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